9 research outputs found
Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3-and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study
Introduction: Over 70% of traumatic brain injuries (TBI) are classified as mild (mTBI),
which present heterogeneously. Associations between pre-injury comorbidities and
outcomes are not well-understood, and understanding their status as risk factors may
improve mTBI management and prognostication.
Methods: mTBI subjects (GCS 13–15) from TRACK-TBI Pilot completing 3- and
6-month functional [Glasgow Outcome Scale-Extended (GOSE)] and post-concussive
outcomes [Acute Concussion Evaluation (ACE) physical/cognitive/sleep/emotional
subdomains] were extracted. Pre-injury comorbidities >10% incidence were included
in regressions for functional disability (GOSE ≤ 6) and post-concussive symptoms by
subdomain. Odds ratios (OR) and mean differences (B) were reported. Significance was
assessed at p < 0.0083 (Bonferroni correction).
Results: In 260 subjects sustaining blunt mTBI, mean age was 44.0-years and 70.4%
were male. Baseline comorbidities >10% incidence included psychiatric-30.0%, cardiac
(hypertension)-23.8%, cardiac (structural/valvular/ischemic)-20.4%, gastrointestinal15.8%, pulmonary-15.0%, and headache/migraine-11.5%. At 3- and 6-months
separately, 30.8% had GOSE ≤ 6. At 3-months, psychiatric (GOSE ≤ 6: OR = 2.75,
95% CI [1.44–5.27]; ACE-physical: B = 1.06 [0.38–1.73]; ACE-cognitive: B = 0.72
[0.26–1.17]; ACE-sleep: B = 0.46 [0.17–0.75]; ACE-emotional: B = 0.64 [0.25–1.03]), headache/migraine (GOSE ≤ 6: OR = 4.10 [1.67–10.07]; ACE-sleep: B = 0.57
[0.15–1.00]; ACE-emotional: B = 0.92 [0.35–1.49]), and gastrointestinal history
(ACE-physical: B = 1.25 [0.41–2.10]) were multivariable predictors of worse outcomes.
At 6-months, psychiatric (GOSE ≤ 6: OR = 2.57 [1.38–4.77]; ACE-physical: B = 1.38
[0.68–2.09]; ACE-cognitive: B = 0.74 [0.28–1.20]; ACE-sleep: B = 0.51 [0.20–0.83];
ACE-emotional: B = 0.93 [0.53–1.33]), and headache/migraine history (ACE-physical:
B = 1.81 [0.79–2.84]) predicted worse outcomes.
Conclusions: Pre-injury psychiat
Calidad de vida en pacientes con diferentes subtipos de estreñimiento de acuerdo a los criterios de ROMA III
Antecedentes: El estreñimiento funcional y el sĂndrome de intestino irritable con estreñimiento son altamente prevalentes y generan alteraciĂłn en la calidad de vida de quienes los padecen.
Objetivos: Evaluar la calidad de vida en pacientes con estreñimiento funcional y sĂndrome de intestino irritable, de acuerdo a los criterios de ROMA III, utilizando cuestionarios: PAC-QOL y SF-36.
Materiales y mĂ©todos: Estudio transversal tipo encuesta autoadministrado. Se aplicĂł PAC-QOL, SF-36 y cuestionario modular de estreñimiento ROMA III a pacientes con queja de estreñimiento en la consulta externa de un hospital de tercer nivel. Los subtipos de estreñimiento fueron: estreñimiento funcional (sin dolor), sĂndrome de intestino irritable con estreñimiento (dolor y/o malestar ≥ 3 dĂas/mes) y estreñimiento no clasificable (dolor ≤ 2 dĂas/mes). Los datos se resumen en proporciones, y se realizaron comparaciones entre la puntuaciĂłn de cada uno de los rubros de ambos cuestionarios entre los grupos utilizando pruebas paramĂ©tricas (t-Student y ANOVA).
Resultados: Se analizaron 43 encuestas PAC-QOL, sĂndrome de intestino irritable con estreñimiento (14%), estreñimiento funcional (37%) y estreñimiento no clasificable (49%), encontrándose diferencia estadĂsticamente significativa (p < 0.05) en Malestar fĂsico (sĂndrome de intestino irritable con estreñimiento vs. estreñimiento funcional y estreñimiento no clasificable vs. sĂndrome de intestino irritable con estreñimiento), Preocupaciones (sĂndrome de intestino irritable con estreñimiento vs. estreñimiento funcional) y SatisfacciĂłn con el tratamiento (sĂndrome de intestino irritable con estreñimiento vs. estreñimiento funcional y estreñimiento no clasificable vs. sĂndrome de intestino irritable con estreñimiento). Se analizaron 93 encuestas SF-36, sĂndrome de intestino irritable con estreñimiento (23%), estreñimiento funcional (27%) y estreñimiento no clasificable (51%), encontrándose menor energĂa fĂsica entre sĂndrome de intestino irritable con estreñimiento vs. estreñimiento funcional (p < 0.0221) y estreñimiento no clasificable (p < 0.0086) respectivamente, y mayor dolor fĂsico al compararse con sĂndrome de intestino irritable con estreñimiento vs. estreñimiento no clasificable (p < 0.0362).
Conclusiones: Utilizando los cuestionarios PAC-QOL y SF-36 se identifican diferencias en la calidad de vida en los subtipos de estreñimiento. Los pacientes con la variante sĂndrome de intestino irritable con estreñimiento experimentan menor calidad de vida en todos los dominios evaluados
The Mexican consensus on fecal incontinence
Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self-esteem, and interferes with everyday activities, in turn, favoring social isolation. There are no guidelines or consensus in Mexico on the topic, and so the AsociaciĂłn Mexicana de GastroenterologĂa brought together a multidisciplinary group (gastroenterologists, neurogastroenterologists, and surgeons) to carry out the «Mexican consensus on fecal incontinence» and establish useful recommendations for the medical community.The present document presents the formulated recommendations in 35 statements. Fecal incontinence is known to be a frequent entity whose incidence increases as individuals age, but one that is under-recognized. The pathophysiology of incontinence is complex and multifactorial, and in most cases, there is more than one associated risk factor. Even though there is no diagnostic gold standard, the combination of tests that evaluate structure (endoanal ultrasound) and function (anorectal manometry) should be recommended in all cases. Treatment should also be multidisciplinary and general measures and drugs (lidamidine, loperamide) are recommended, as well as non-pharmacologic interventions, such as biofeedback therapy, in selected cases. Likewise, surgical treatment should be offered to selected patients and performed by experts. Resumen: La incontinencia fecal es el paso involuntario o la incapacidad de controlar la descarga de materia fecal a travĂ©s del ano, siendo una condiciĂłn que deteriora significativamente la calidad de vida de los sujetos que la padecen, ya que afecta la imagen corporal, la autoestima e interfiere con las actividades cotidianas favoreciendo el aislamiento social. En nuestro paĂs no existe una guĂa o consenso al respecto, por lo que la AsociaciĂłn Mexicana de GastroenterologĂa reuniĂł a un grupo multidisciplinario (gastroenterĂłlogos, neurogastroenterolĂłgos y cirujanos), para que realizaran el Consenso mexicano sobre incontinencia fecal y se establecieran recomendaciones de utilidad para la comunidad mĂ©dica.Las recomendaciones emitidas fueron a travĂ©s de 35 enunciados que se presentan en este documento. Se reconoce que la incontinencia fecal es una entidad frecuente, y cuya incidencia se incrementa conforme aumenta la edad, sin embargo, es poco reconocida. La fisiopatologĂa de la incontinencia es compleja y multifactorial y en la mayorĂa de los casos existe más de un factor de riesgo asociado. Respecto al diagnĂłstico, se considera que, si bien no existe un estándar de oro, la combinaciĂłn de pruebas que evalĂşen la estructura (p. ej., ultrasonido endoanal) y la funciĂłn (manometrĂa anorrectal) se debe de recomendar en todos los casos. El tratamiento debe ser tambiĂ©n multidisciplinario, y se recomiendan medidas generales, fármacos (lidamidina, loperamida), y en casos seleccionados intervenciones no farmacolĂłgicas como la terapia de biorretroalimentaciĂłn. De igual manera, el tratamiento quirĂşrgico debe ofrecerse a los pacientes seleccionados y debe ser brindado por los expertos
Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico
Celiac disease, celiac sprue, or gluten-sensitive enteropathy, is a generalized autoimmune disease characterized by chronic inflammation and atrophy of the small bowel mucosa. It is caused by dietary exposure to gluten and affects genetically predisposed individuals. In Mexico, at least 800,000 are estimated to possibly have the disease, prompting the AsociaciĂłn Mexicana de GastroenterologĂa to summon a multidisciplinary group of experts to develop the “Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico” and establish recommendations for the medical community, its patients, and the general population. The participating medical professionals were divided into three working groups and were given the selected bibliographic material by the coordinators (ART, LUD, JMRT), who proposed the statements that were discussed and voted upon in three sessions: two voting rounds were carried out electronically and one at a face-to-face meeting. Thirty-nine statements were accepted, and once approved, were developed and revised by the coordinators, and their final version was approved by all the participants. It was emphasized in the document that epidemiology and risk factors associated with celiac disease (first-degree relatives, autoimmune diseases, high-risk populations) in Mexico are similar to those described in other parts of the world. Standards for diagnosing the disease and its appropriate treatment in the Mexican patient were established. The guidelines also highlighted the fact that a strict gluten-free diet is essential only in persons with confirmed celiac disease, and that the role of gluten is still a subject of debate in relation to nonceliac, gluten-sensitive patients. Resumen: La enfermedad celiaca (EC), esprĂşe celĂaco o enteropatĂa sensible al gluten, es una enfermedad autoinmune generalizada que se caracteriza por inflamaciĂłn crĂłnica y atrofia de la mucosa del intestino delgado, causada por la exposiciĂłn al gluten de la dieta que afecta a individuos genĂ©ticamente predispuestos. En MĂ©xico se estima que al menos 800,000 personas podrĂan padecerla, por lo que la AsociaciĂłn Mexicana de GastroenterologĂa convocĂł a un grupo multidisciplinario de expertos para que realizaran la GuĂa clĂnica para diagnĂłstico y tratamiento de enfermedad celĂaca en MĂ©xico, y se establecieran recomendaciones para la comunidad mĂ©dica, sus enfermos y la poblaciĂłn general. Los profesionistas participantes, divididos en 3 mesas de trabajo, recibieron material bibliográfico seleccionado por los coordinadores (ART, LUD, JMRT), quienes propusieron los enunciados que fueron discutidos y votados en 3 sesiones: 2 a travĂ©s de medios electrĂłnicos y una presencial. Al final se aceptaron 39 enunciados que, una vez aprobados, fueron desarrollados y revisados por los coordinadores hasta su versiĂłn final, que fue aprobada por todos los participantes. Dentro de estas se destaca que la epidemiologĂa y factores de riesgo asociados (familiares de primer grado, enfermedades autoinmunes, poblaciones de alto riesgo) a EC en MĂ©xico son similares a los descritos en otras partes del mundo. Se establecen pautas para el diagnĂłstico y el tratamiento apropiado de los pacientes mexicanos que la padecen. Se insiste en que una dieta estricta libre de gluten es indispensable solo en las personas con EC confirmada, y que su papel en pacientes con sensibilidad al gluten sin EC es aĂşn un tema de controversia. Keywords: Celiac disease, Mexico, Diagnosis, Gluten, Allergy, Sensitivity, Palabras clave: Enfermedad celĂaca, MĂ©xico, DiagnĂłstico, Gluten, Alergia, Sensibilida