Quiste de colédoco y embarazo. Reporte de 3 casos y revisión de la bibliografía

ResumenAntecedentesLos quistes de colédoco son una enfermedad rara que afecta principalmente a mujeres en la infancia, pero que pueden presentarse durante el embarazo. Sus síntomas y signos están opacados por los cambios en esta fase, por lo que el diagnóstico puede ser tardío y sus complicaciones poner en peligro tanto a la madre como al producto.ObjetivoPresentar 3 casos de quiste de colédoco en embarazadas, tratadas en un hospital de tercer nivel.Casos clínicosPresentamos 3 pacientes con diagnóstico de quiste de colédoco durante el embarazo. Dos desarrollaron datos de colangitis; la primera fue intervenida quirúrgicamente con anastomosis hepaticoyeyunal, pero abortó y falleció al décimo día del postoperatorio. La segunda tuvo una cesárea pretérmino por sufrimiento fetal; 4 semanas después fue intervenida con anastomosis hepaticoyeyunal, pero tuvo una perforación gástrica y falleció por complicaciones sépticas. La tercera no desarrolló colangitis, tuvo un embarazo sin complicaciones, se le realizó anastomosis hepaticoyeyunal 4 semanas después, con buenos resultados.ConclusionesEl tratamiento de los quistes de colédoco durante el embarazo está relacionado con la presencia de colangitis. Cuando no responden al tratamiento médico, la descompresión de la vía biliar está indicada. El tratamiento definitivo debe realizarse una vez resuelto el embarazo.AbstractBackgroundCholedochal cysts are rare. They usually present during childhood in women, but it can also be seen during pregnancy. Clinical signs and symptoms are obscured during this time, thus it can complicate the diagnosis and represent a life threatening complication for both the mother and the child.ObjectiveTo communicate the case of 3 pregnant patients with choledochal cyst.Clinical casesThree pregnant women in which choledochal cyst were diagnosed. Two developed signs of cholangitis. The first one underwent a hepatic-jejunostomy, but had an abortion and died on postoperative day 10. The second one had a preterm caesarean operation due to foetal distress and underwent a hepatic-jejunostomy 4 weeks later; during her recovery she had a gastric perforation and died of septic complications. The third one did not develop cholangitis or jaundice. She had an uneventful pregnancy and had a hepatic-jejunostomy 4 weeks later with good results.ConclusionsManagement of choledochal cysts during pregnancy is related to the presence of cholangitis. When they do not respond to medical treatment, decompression of the biliary tree is indicated. Definitive treatment should be performed after resolution of the pregnancy

Initial Diagnostic Evaluation in the Virtual High School Careers of the Catholic of the North University Foundation. Quasi-Experimental Study

RESUMEN: El propósito del artículo es evaluar los efectos de la evaluación diagnóstica inicial sobre el rendimiento académico en cursos de Psicología e Ingeniería Informática de la Católica del Norte Fundación Universitaria. Se planteó un diseño cuasi-experimental pretest-postest con grupo control, puesto que son grupos intactos ya constituidos, no seleccionados aleatoriamente. Se compararon los resultados (Pretest-Postest) de ambos grupos para derivar las ganancias entre las dos pruebas. Finalmente se realizó una discusión de los resultados y se plantearon las conclusiones, entre las cuales se verificó la incidencia del tratamiento sobre el rendimiento académico y la metacognición. La evaluación diagnóstica permitió a los estudiantes darse cuenta de si tenían o no los conceptos previos requeridos para un buen funcionamiento en los cursos, y a los facilitadores nivelar los conocimientos de los estudiantes para asegurar los logros esperados.ABSTARCT: The purpose of this article is to evaluate the effects of the initial diagnostic evaluation on the academic performance in the Psychology and Systems Engineering courses of the Catholic of the North University Foundation. It was proposed a quasi-experimental design pre-post test with a control group, because they are novel groups already constituted, and not selected randomly. The pre-post test results of both groups were compared to obtain the gains among the tests. Finally we made a discussion on the results and the conclusions were proposed, among others it was verified the influence of the treatment on the academic performance and on the metacognition. The diagnostic evaluation allowed students to become aware whether they had or not the previous concepts required for a good performance in the courses, and for the teachers to put on the same level the knowledge of the students in order to achieve the expected results

Sex-differences in the oxygenation levels of intercostales and vastus lateralis muscles during incremental exercise

This study aimed to examine sex differences in oxygen saturation in respiratory (SmO2-m.intercostales) and locomotor muscles (SmO2-m.vastus lateralis) while performing physical exercise. Twenty-five (12 women) healthy and physically active participants were evaluated during an incremental test with a cycle ergometer, while ventilatory variables (lung ventilation [V ̇E], tidal volume [Vt], and respiratory rate [RR]) were acquired through the breath-by-breath method. SmO2 was acquired using the MOXY devices on the m.intercostales and m.vastus lateralis. A two-way ANOVA (sex × time) indicated that women showed a greater significant decrease of SmO2-m.intercostales, and men showed a greater significant decrease of SmO2-m.vastus lateralis. Additionally, women reached a higher level of ΔSmO2-m.intercostales normalized to V ̇E (L·min-1) (p<0.001), whereas men had a higher level of ΔSmO2-m.vastus lateralis normalized to peak workload-to-weight (watts·kg-1, PtW) (p=0.049), as confirmed by Student's t-test. During an incremental physical exercise, women experienced a greater cost of breathing, reflected by greater deoxygenation of the respiratory muscles, whereas men had a higher peripheral load, indicated by greater deoxygenation of the locomotor muscles

Comportamiento reproductivo de ganado bovino lechero en clima tropical. 5. Efecto de raza, producción láctea y peso corporal sobre los niveles de triyodotironina en dos estaciones del año

Se evaluó el efecto de raza: Holstein (H), Cebú (C) y Holstein X Cebú (HC); y estación del año: (EC = cálida; EF = fría) sobre los niveles de triyodotironina (Ta) de vacas lactantes en el trópico

The prevalence of multidrug-resistant Salmonella in raw shrimp and octopus in Campeche, Mexico

Introduction: Multidrug-resistant (MDR) pathogenic bacteria in seafood, especially shrimp and octopus, are significant public health concerns and are able to be transmitted to humans in foodstuffs, particularly when they are of animal origin. The present study was conducted to measure the antimicrobial susceptibility patterns and prevalence of Salmonella isolates obtained from octopus and shrimp in San Francisco de Campeche, Mexico. Methods: Two hundred shrimp and octopus samples (one hundred each) were collected from the municipal market, and each sample consisted of 100 g. The present study used conventional methods to identify and isolate Salmonella, with the disk-diffusion method used to screen all isolates for sensitivity to 12 antibiotics. Results: The prevalence of Salmonella was found to be 56% and 45% in shrimp and octopus, respectively. The high levels of Salmonella observed in the municipal market sampled by the present study reveal poor sanitary conditions in the processing and transport of the products of interest and those handling them at the point of sale. All the Salmonella strains were resistant to at least three antimicrobial classes. All shrimp isolates (100%) presented susceptibility to chloramphenicol and the majority (88%) presented sensitivity to ciprofloxacin, while the strains isolated in the octopus individuals sampled presented sensitivity to both the foregoing antibiotics (74% and 90%, respectively). Conclusion: Based on the high prevalence in the samples analyzed, our results suggest that shrimp and octopus could be involved in Salmonella infections in the population

Principales medidas de profilaxis en endoscopia bariátrica. Guía Española de Recomendación de Expertos

Bariatric endoscopy (BE) encompasses a number of techniques -some consolidated, some under development- aiming to contribute to the management of obese patients and their associated metabolic diseases as a complement to dietary and lifestyle changes. To date different intragastric balloon models, suture systems, aspiration methods, substance injections and both gastric and duodenal malabsorptive devices have been developed, as well as endoscopic procedures for the revision of bariatric surgery. Their ongoing evolution conditions a gradual increase in the quantity and quality of scientific evidence about their effectiveness and safety. Despite this, scientific evidence remains inadequate to establish strong grades of recommendation allowing a unified perspective on prophylaxis in BE. This dearth of data conditions leads, in daily practice, to frequently extrapolate the measures that are used in bariatric surgery (BS) and/or in general therapeutic endoscopy. In this respect, this special article is intended to reach a consensus on the most common prophylactic measures we should apply in BE. The methodological design of this document was developed while attempting to comply with the following 5 phases: Phase 1: delimitation and scope of objectives, according to the GRADE Clinical Guidelines. Phase 2: setup of the Clinical Guide-developing Group: national experts, members of the Grupo Español de Endoscopia Bariátrica (GETTEMO, SEED), SEPD, and SECO, selecting 2 authors for each section. Phase 3: clinical question form (PICO): patients, intervention, comparison, outcomes. Phase 4: literature assessment and synthesis. Search for evidence and elaboration of recommendations. Based on the Oxford Centre for Evidence-Based Medicine classification, most evidence in this article will correspond to level 5 (expert opinions without explicit critical appraisal) and grade of recommendation C (favorable yet inconclusive recommendation) or D (inconclusive or inconsistent studies). Phase 5: External review by experts. We hope that these basic preventive measures will be of interest for daily practice, and may help prevent medical and/or legal conflicts for the benefit of patients, physicians, and BE in general

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease : A Multicentre Study of Geteccu

Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered "exposed". The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2-2.0), urgent surgery (OR: 1.6; 95% CI: 1.2-2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1-1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3-2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97-1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03-2.27). Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on Ustekinumab

Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients' data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index <= 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission