Uso de Hemospray® en sangrado post-escleroterapia

Introducción: Hemospray® es un nuevo dispositivo para hemostasia endoscópica utilizado para el sangrado gastrointestinal no variceal. Permite la hemostasia mediante la activación plaquetaria y el aumento de la concentración de factores de coagulación, así como la formación de una barrera mecánica sobre la pared de un vaso sangrante creando un tapón mecánico en el sitio de sangrado. Dentro de las principales indicaciones para su uso se encuentran lesiones de difícil acceso endoscópico, hemorragia gastrointestinal masiva, múltiples sitios de sangrado, modificación de la anatomía por terapia endoscópica previa, presencia de coagulopatía, dificultad para tener visualización directa o cuando es imposible tener contacto con la lesión sangrante. Sin embargo, su uso en niños aún no ha sido aprobado por la FDA. Existe un caso publicado de un paciente de 11 meses tratado exitosamente con Hemospray® por hemorragia gastrointestinal no variceal. Caso clínico: Se reporta el caso de una paciente de 2 años con falla hepática aguda y cirrosis biliar primaria con hipertensión portal y sangrado post-escleroterapia. Se analizó el caso para sustentar las nuevas terapias para el control del sangrado masivo en úlceras post-escleroterapia. Conclusiones: La aplicación demostró ser segura y sin efectos adversos. El uso de Hemospray® es una alternativa efectiva en el control del sangrado gastrointestinal

High-stable mesoporous Ni-Ce/clay catalysts for syngas production

A mesoporous-type catalytic support was synthesized through the modification of a smectite with polyvinyl alcohol (PVA) and microwaves. Texture and micro-morphology of the support was determined. Several techniques were employed in order to describe the chemical environment of active species on the surface. Ni0 particle sizes were dependent on the structural site of reducible species. High stable Ni-Ce catalysts (calcined at 800 °C) were evaluated in the CO2 reforming of methane reaction at 700 °C (WHSV = 96 L g-1 h-1, without dilution gas and pre-reduction). The catalysts have presented CH4 conversions between 40 and 65%, CO2 conversion between 35 and 65% and H2/CO ratios between 0.2 and 0.4. © 2011 Springer Science+Business Media, LLC.C.E. Daza thanks to COLCIENCIAS for his doctorate scholarship. W. Y. Hernandez thanks to ALBAN program for his doctorate scholarship. The authors thank to project No 201010011587 DIB Universidad Nacional de Colombia and Professor Carlos R. Cabrera at Puerto Rico University for XPS measurements.Peer Reviewe

Obtención de un índice de sustentabilidad aplicado a materiales de construcción

Este artículo aplica dos conceptos con la finalidad de obtener un índice de sustentabilidad para edificaciones. El primero se refiere al análisis del ciclo de vida de materiales de construcción, evaluado con parámetros como el calentamiento global, partículas cancerígenas y no cancerígenas, contaminantes del aire, eutrofización, ecotoxicidad, smog, el agotamiento de los recursos naturales, calidad del aire interior, y el agotamiento de la capa de ozono. El segundo concepto es la aplicación de Sistemas de Inferencia Borrosa (Fuzzy Inference Systems, FIS) el cual es un modelo que intenta emular el proceso de razonamiento de un experto en el área de construcciones y medio ambiente, a través del cual se calcula un índice sobre la sustentabilidad de los materiales utilizados en un edificio, que toma en cuenta el ciclo de vida de los mismos. Dichos materiales han sido previamente analizados mediante el programa computacional SimaPro, un software de evaluación de ciclo de vida que considera variables consensadas internacionalmente

Terapia combinada con coil y cianoacrilato guiada por ultrasonido endoscópico en una várice gástrica fúndica

La hemorragia por várices gástricas suele ser más severa y mortal que la causada por várices esofágicas. La terapia vascular guiada por ultrasonido endoscópico (TV-USE) ha demostrado ser un método eficaz y seguro con baja tasa de recurrencia en el tratamiento de la hemorragia por várices gástricas. Se presenta el caso de un paciente con hemorragia causada por una várice gástrica de 3 cm de diámetro quien recibió TV-USE combinada con coil y cianoacrilato con la intención de mostrar las ventajas de la TV-USE combinada

Assessment of the Role of a Second Evaluation of Capsule Endoscopy Recordings to Improve Diagnostic Yield and Patient Management

Introduction: The diagnostic yield (DY) of small-bowel capsule endoscopy (SBCE) varies considerably according to its indication. Some strategies have been used to increase DY with varying results. The intention of this study was to identify whether evaluation of the SBCE recordings by a second reviewer can increase DY and change patient management. Methods: One hundred SBCEs with different indications, already read by an endoscopist were read by a second blinded endoscopist. When the results of the 2 readings were different, the images were discussed by the endoscopists; if no consensus was reached, they took the opinion of a third endoscopist into account. All the participating endoscopists had experience in reading SBCEs (i.e., >50 per year). The SBCE findings were divided into positive (vascular lesions, ulcers, and tumors), equivocal (erosions or red spots), and negative. The interobserver agreement and the increase in DY were assessed as well as the percentage of false-negatives (FNs) in the first evaluation. Results: The indications for SBCE were small-bowel bleeding (SBB) in 48 cases, Crohn’s disease (CD) in 30, and other causes (iron-deficiency anemia, small-bowel tumors, and diarrhea) in 22. There was substantial interobserver agreement between evaluations (κ = 0.79). The findings in the first evaluation were positive in 60%, equivocal in 20% and, negative in 20%. In the second evaluation, 66% were positive, 18% were equivocal, and 16% were negative. The increase in DY with the second reading was 6% (p = 0.380), i.e., 6.3% for SBB, 4.4% for CD and 9.2% for other indications, resulting in a change in management of 4% of the patients. FNs in the first SBCE reading were found in 4% of the SBCEs. Discussion: A second evaluation of the SBCE recordings identified significant pathology that the first evaluation had missed, resulting in a nonsignificant 6% increase in DY and a change in the management of 4% of the patients

Prevalence of gastrointestinal disorders in adults with common variable immunodeficiency at Specialty Hospital Dr. Bernardo Sepulveda

Background: The common variable immunodeficiency (CVID) shows a variable incidence, from 1:15,000 to 1:117,000, whitout gender predominance. The incidence of gastrointestinal manifestations in these patients ranges from 20-60%, and these may be the first and only clinical mafifestation of CVID, while other patients develop gastrointestinal complicatons during the course of it. Objective: To determinate the prevalence of gastrointestinal manifestations in adult patients with CVID. Material and method: A descriptive, cross-sectional and observational study was made including patients with CVID attending Primary Immunodeficiency Clinic of Allergy and Clinical Immunology Department, Specialties Hospital, National Medical Center SXXI, Mexico City. All patients underwent gastrointestinal symptoms questionnaire, laboratory, cabinet, endoscopy and breath test for bacterial overgrowth. Results: We evaluated 17 patients, 8 men and 9 women with an average age of 36 years with a definitive diagnosisi of CVID according to international criteria; 59% had abdominal pain, 53% abdominal distension; only 3 patients (17.6%) reported constipatión; 47% had chronic diarrhea, of wich only 2 (11.8%) had rectal pushing. The diagnoses of gastrointestinal manifestations of this population were: 18% cronic diarrhea, celic disease and bacterialovergrowth, 24% gatrointestinal functional disorder, 12% contipation and 6% dyspepsia. One patient (6%) had nogastrointestinal symptoms. Conclusions: Prevalence of gastrointestinal diseases in adult patients with common variable immunodeficiency was 94%. There was no gender predominance. It is therefore important the patients with Cvid will conduct a study protocol that includes a complete medical history considering gastrointestinal symptoms and sings, in order todeterminate timely diagnosis and therapeutic approach

Adherence to recommendations for endoscopy practice during COVID-19 pandemic in Latin America: how are we doing it?

Background and aims Digestive endoscopy is considered a high-risk procedure for COVID-19. Recommendations have been made for its practice during the pandemic. This study was conducted to determine adherence to recommendations for endoscopy practice during the COVID-19 pandemic in Latin America (LA).Methods A survey was conducted of endoscopists from LA consisting of 43 questions for the evaluation of four items: general and sociodemographic features, and preprocedure, intraprocedure and postprocedure aspects.Results A response was obtained from 338 endoscopists (response rate 34.5%) across 15 countries in LA. In preprocedure aspects (hand washing, use of face masks for patients, respiratory triage area, training for the placement/removal of personal protective equipment (PPE) and availability of specific area for the placement/removal of PPE), there was adherence in <75%. Regarding postprocedure aspects, 77% (261/338) had reused PPE, mainly the N95 respirator or higher, and this was with a standardised decontamination procedure only in 32% (108/338) of the time. Postprocedure room decontamination was carried out by 47% on >75% of occasions. In relationship to intraprocedure aspects (knowledge of risk and type of endoscopic procedures, use of PPE, airway management in patients and infrastructure), there was adherence in >75% for all the parameters and 78% of endoscopists only performed emergencies or time-sensitive procedures.Conclusions Adherence to the recommendations for endoscopy practice during the COVID-19 pandemic is adequate in the intraprocedure aspect. However, it is deficient in the preprocedure and postprocedure aspects