Obstrucción arterial aguda

La obstrucción arterial aguda es una entidad clínica íntimamente relacionada con patologías de manejo frecuente tales como la HTA, DBT, dislipidemias, entre otras, que no identificada y tratada en forma temprana no sólo puede llevar a una amputación con los consiguientes trastornos psíquicos, sociales y económicos para el paciente, sino que puede resultar fatal. Por tal razón, elaboramos este artículo con el objeto de identificar los signos y síntomas que nos pueden llevar a un diagnóstico precoz y dar a conocer la importancia de un manejo adecuado.Después de haber realizado esta revisión bibliográfica podemos concluir que la obstrucción arterial aguda ya sea por embolia, trombosis aguda u otra causa es una emergencia médica – quirúrgica de primer orden, junto con la ruptura de un aneurisma o las lesiones vasculares traumáticas; sólo un diagnóstico y tratamiento tempranos pueden lograr salvar la región afecta

Hemorragia digestiva alta: revisión bibliográfica

Hemos realizado esta revisión bibliográfica teniendo como objetivos principales: aclarar conceptos básicos y actualizar los conocimientos en cuanto al diagnóstico y tratamiento de la hemorragia digestiva alta (HDA).Esta patología sigue siendo una de las complicaciones más graves del aparato digestivo; su incidencia es de aproximadamente 50-150 pacientes por 100.000 habitantes/año que precisan ser hospitalizados.Entre las causas habituales que desencadenan un cuadro de HDA podemos citar a: la úlcera péptica, la gastritis erosiva relacionada con la ingesta reciente de alcohol o con el empleo de antiinflamatorios tales como la aspirina, desgarro de la mucosa esófago-gástrica y la ruptura de várices esofágicas. Los recientes avances en el tratamiento endoscópico de la HDA, han demostrado que es una medida útil y altamente recomendable, así como el tratamiento erradicador de Helicobacter Pylori ya que mejoran notablemente el pronóstico de estos pacientes y su evolución clínica.Luego de haber elaborado esta revisión bibliográfica podemos concluir que la HDA es una emergencia médico quirúrgica que tiene una elevada mortalidad, a pesar de los avances terapéuticos de los últimos años

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients

BackgroundPrevious studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. MethodsProspective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. ResultsWe included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 +/- 12 vs. 54 +/- 16 years, p < 0.001), had been diagnosed younger (31 +/- 12 vs. 36 +/- 15 years, p < 0.001), and had a shorter disease duration (14 +/- 7 vs. 18 +/- 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92-2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0-1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. ConclusionsCompared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case–Control Study (COVID-19-EII)

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case-control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March-July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3-5.9), occupational risk (OR: 2.9; 95%CI: 1.8-4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2-2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09-0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution

TIC PARTE INTEGRAL DE LA INFRAESTRUCTURA PÚBLICA EDUCATIVA EN ECUADOR

Las TIC han provocado cambios no sólo en la sociedad sino también en el ámbito de la&nbsp;educación, trayendo exigencias en las infraestructuras de las instituciones educativas. Se pretende&nbsp;indagar sobre las características que actualmente tienen las infraestructuras de las instituciones&nbsp;educativas públicas del Ecuador y conocer si cuentan con los parámetros básicos como el acceso a&nbsp;internet, sala de cómputos, herramientas digitales, entre otros. Se mencionan algunas investigaciones&nbsp;encontrados sobre el tema, así como el análisis de los marcos regulatorios más significativos que han&nbsp;regido el funcionamiento de estas instituciones. El presente artículo está distribuido de la siguiente&nbsp;forma: En la sección I se encuentra la introducción, en la sección II se presenta el desarrollo y en la&nbsp;sección III se muestra las conclusiones donde realiza un análisis sobre el presupuesto económico que se&nbsp;tiene destinado a la educación con la intención de proponer cuales son los rubros que se debe de poner&nbsp;mayor énfasis para lograr la infraestructura educativa idónea que demandan las exigencias del siglo&nbsp;XXI

Nationwide COVID-19-EII Study : Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry

We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March-July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged ≥ 60 years (OR 7.1, 95% CI: 1.8-27 and 4.5, 95% CI: 1.3-15.9), while having ≥2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3-11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD