Consenso mexicano sobre dolor torácico no cardiaco

Introducción: Dolor torácico no cardíaco (DTNC) se define como un síndrome clínico caracte-rizado por dolor retroesternal semejante a la angina de pecho, pero de origen no cardiaco ygenerado por enfermedades esofágicas, osteomusculares, pulmonares o psiquiátricas.Objetivo: Presentar una revisión consensuada basada en evidencias sobre definición, epidemio-logía, fisiopatología, diagnóstico y opciones terapéuticas para pacientes con DTNC.Métodos: Tres coordinadores generales realizaron una revisión bibliográfica de todas las publi-caciones en inglés y espa˜nol sobre el tema y elaboraron 38 enunciados iniciales divididosen tres categorías principales: 1) definiciones, epidemiología y fisiopatología; 2) diagnóstico,y 3) tratamiento. Los enunciados fueron votados (3 rondas) utilizando el sistema Delphi, y losque alcanzaron un acuerdo > 75% fueron considerados y calificados de acuerdo con el sistemaGRADE. Resultados y conclusiones: El consenso final incluyó 29 enunciados Todo paciente que debutacon dolor torácico debe ser inicialmente evaluado por un cardiólogo. La causa más común deDTNC es la enfermedad por reflujo gastroesofágico (ERGE). Como abordaje inicial, si no existensíntomas de alarma, se puede dar una prueba terapéutica con inhibidor de bomba de pro-tones (IBP) por 2-4 semanas. Si hay disfagia o síntomas de alarma, se recomienda hacer unaendoscopia. La manometría de alta resolución es el mejor método para descartar trastornosmotores espásticos y acalasia. La pHmetría ayuda a demostrar exposición esofágica anormal alácido. El tratamiento debe ser dirigido al mecanismo fisiopatológico, y puede incluir IBP, neu-romoduladores y/o relajantes de músculo liso, intervención psicológica y/o terapia cognitiva,y ocasionalmente cirugía o terapia endoscópica. ABSTRACT Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by retros-ternal pain similar to that of angina pectoris, but of non-cardiac origin and produced byesophageal, musculoskeletal, pulmonary, or psychiatric diseases.Aim: To present a consensus review based on evidence regarding the definition, epidemiology,pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options forthose patients. Methods: Three general coordinators carried out a literature review of all articles published inEnglish and Spanish on the theme and formulated 38 initial statements, dividing them into 3 maincategories: (i) definitions, epidemiology, and pathophysiology; (ii) diagnosis, and (iii) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statementswere those that reached > 75% agreement, and they were rated utilizing the GRADE system.Results and conclusions: The final consensus included 29 statements. All patients presentingwith chest pain should initially be evaluated by a cardiologist. The most common cause ofnon-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. Ifdysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution mano-metry is the best method for ruling out spastic motor disorders and achalasia and pH monitoringaids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at thepathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/orsmooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionallysurgery or endoscopic therapy

The Mexican consensus on non-cardiac chest pain

Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by ret-rosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced byesophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology,pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options forthose patients. Methods Three general coordinators carried out a literature review of all articles published inEnglish and Spanish on the theme and formulated 38 initial statements, dividing them into 3 maincategories: 1) definitions, epidemiology, and pathophysiology, 2) diagnosis, and 3) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statementswere those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions The final consensus included 29 statements. All patients presentingwith chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initialapproach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagiaor alarm symptoms are present, endoscopy is recommended. High-resolution manometry isthe best method for ruling out spastic motor disorders and achalasia and pH monitoring aidsin demonstrating abnormal esophageal acid exposure. Treatment should be directed at thepathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/orsmooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionallysurgery or endoscopic therapy

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Padina caulescens and Schizochytrium sp. as Supplemented Feed in the Nursery Production of Penaeus vannamei Post Larvae Reared in Biofloc Systems

The appearance of diverse diseases in cultured shrimp has led to the search for alternative prevention strategies. One of these alternatives is Biofloc technology (BFT). However, this requires further optimization. The objective of this work is to improve this system by adding microalgae (Schizochytrium sp.), probiotic bacteria (Lactobacillus fermentum), and macroalga (Padina caulescens), which in addition to maintaining the quality of water in the Penaeus vannamei culture, improves growth parameters at the maternity stage. We installed an experiment that included six different treatments in culture tanks containing 250 L of seawater each, and 500 shrimp (68 mg) m/3, and evaluated the results for 35 days, in which we gradually decreased the inert-feed to 50-75% and substituted it with 50-25% of P. caulescens. The results showed that, in comparison to the control, survival, and final weight of the shrimps improved and improved further with the use of probiotic bacteria, Schizochytrium sp. and P. caulescens and probiotic bacteria enabled a reduction of 50% of the inert feed. Therefore, we recommended the use of P. caulescens, Schizochytrium sp. (LPU-1), and L. fermentum (T-19) in BFT cultures for P. vannamei

Effect of ripening on physico-chemical properties and bioactive compounds in papaya pulp, skin and seeds

47-59Byproducts generated by the food industry represent an alternative to obtain functional ingredients. Byproducts of tropical fruits, such as papaya skin and seeds, represent a source of bioactive compounds (BC), which could change during fruit ripening. Effect of ripening stage (RS) on BC content and antioxidant properties of edible pulp, skin and seeds of papaya cv. Maradol was determined. Papaya skin showed significantly higher ascorbic acid (~250 mg AAE/100 g) content than seeds (~20 mg/100 g), while pulp had the highest values (~600 mg/100 g). However, papaya skin presented higher total phenolic content (~560 mg GAE/100 g) and flavonoids (~1000 mg QE/100 g) than pulp and seeds. Also, papaya skin showed the highest values followed by pulp and seeds with TEAC, FRAP and DPPH. Papaya skin had higher carotenoids and α-tocopherol (~1500 µg/100 g and ~4000 µg/100 g, respectively) content than pulp and seeds. BC content in each byproduct varied in all RS. Therefore, among the papaya byproducts, skin represents a good source of BC with good antioxidant properties, which may be used to extract them for its incorporation in functional foods depending on RS

Consenso mexicano sobre el síndrome de intestino irritable

Antecedentes: Desde la publicación de las guías de diagnóstico y tratamiento del síndrome del intestino irritable (SII) de la Asociación Mexicana de Gastroenterología en el 2009 (Guías 2009) se han producido avances significativos en el conocimiento de la epidemiología, fisiopatogenia, diagnóstico y tratamiento de esta enfermedad. Objetivos: Presentar una revisión consensuada del estado actual de los conocimientos sobre el SII que actualicen las Guías 2009, integrando las nuevas evidencias científicas publicadas a nivel mundial con énfasis en estudios realizados en México. Métodos: Se realizó una revisión de la bibliografía en PubMed de enero del 2009 a marzo del 2015, que se complementó en forma manual. Se incluyeron todas las publicaciones en inglés y español, con preferencia por los consensos, guías, revisiones sistemáticas y metaanálisis. Se generaron enunciados en los diferentes aspectos de la enfermedad que fueron votados por 24 gastroenterólogos con el método Delphi. Una vez consensuado cada enunciado, se calificó el nivel de la evidencia y se otorgó la fuerza de la recomendación utilizando el sistema GRADE. Resultados: Se generaron 48 enunciados que actualizaron la información sobre el SII y complementaron la información que no había sido incluida en las Guías 2009 con referencia al papel del ejercicio y la dieta, las estrategias diagnósticas, así como alternativas de tratamiento existentes que fueron evaluadas con mayor rigor o que surgieron en los 5 últimos años. Conclusiones: Presentamos una revisión consensuada de los progresos más relevantes en el SII, que actualizan y complementan las Guías 2009. Se incluyen diversos estudios realizados en México