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BACKGROUND OBJECTIVES: Sandflies are vector insects associated with terrestrial forest ecosystems; in the Ecuadorian Andes, they participate in the transmission of human cutaneous leishmaniasis. This geographical area represents an opportunity to evaluate the role of sandflies as bioindicators of the degree of intervention of tropical humid forest ecosystems (THF) associated with changes in the ecology of the local landscape. METHODS: CDC-light traps were used for collecting adult sandflies in February 2020 in a humid tropical forest within the Chocó Biosphere Reserve. All species were identified using morphological keys. Analysis data about abundance, richness, species accumulation, diversity index, species composition communities, species sex proportion, spatial sandflies environmental, Renyi's Diversity Profile were performed to compare six spatial habitats in Mashpi locality, Ecuador. RESULTS: Sandflies were collected (n-1435); the main species are represented by Trichophoromyia reburra, Nyssomyia trapidoi, Psathyromyia aclydifera, Psychodopygus panamensis and Lutzomyia hartmanni. Only Th. reburra is associated with not intervened forest, while the other three species are associated with intervened forest within Mashpi in the Choco Biosphere Reserve. The secondary forest has major sandflies' richness, while the primary forest exhibits major abundance. INTERPRETATION CONCLUSION: Th. reburra is a sandfly restricted to the Andean Forest and is a bioindicator of the high environmental health quality of the forest, while Ny. trapidoi and Pa. aclydifera are bioindicators of environmental disturbances in the forest. Additionally, Ps. panamensis, Lu. hartmanni and Ny. trapidoi are bioindicators of human impact and the risk of leishmaniasis.

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Fraud detection through auditors' manual review of accounting and financial records has traditionally relied on human experience and intuition. However, replicating this task using technological tools has represented a challenge for information security researchers. Natural language processing techniques, such as topic modeling, have been explored to extract information and categorize large sets of documents. Topic modeling, such as latent Dirichlet allocation (LDA) or non-negative matrix factorization (NMF), has recently gained popularity for discovering thematic structures in text collections. However, unsupervised topic modeling may not always produce the best results for specific tasks, such as fraud detection. Therefore, in the present work, we propose to use semi-supervised topic modeling, which allows the incorporation of specific knowledge of the study domain through the use of keywords to learn latent topics related to fraud. By leveraging relevant keywords, our proposed approach aims to identify patterns related to the vertices of the fraud triangle theory, providing more consistent and interpretable results for fraud detection. The model's performance was evaluated by training with several datasets and testing it with another one that did not intervene in its training. The results showed efficient performance averages with a 7% increase in performance compared to a previous job. Overall, the study emphasizes the importance of deepening the analysis of fraud behaviors and proposing strategies to identify them proactively.

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BACKGROUND OBJECTIVES: Sand flies are insects vector associated with terrestrial forest ecosystems; in the Ecuadorian Andes, they participate in the transmission of human cutaneous leishmaniasis. This geographical area is an opportunity to evaluate the role of sand flies as bioindicators od the degree of intervention of a tropical humid forest ecosystems (THF) associated with changes in the ecology of the local landscape. METHODS: CDC-light traps were used for collecting adults' sand flies in February 2020 in a humid tropical forest within Choco Biosphere Reserve. All species were identified using morphological keys. Analysis data about abundance, richness, species accumulation, diversity index, species composition communities, species sex proportion, spatial sand flies environmental, Renyi's Diversity Profile were performed to compare six spatial habitats in Mashpi locality, Ecuador. RESULTS: Sand flies were collected (n-1435); the main species are represented by Th. reburra Ny. trapidoi, Pa. aclydifera, Py. panamensis and Lu. hartmanni. Only Th. reburra is associated with not intervened forest, while the other 3 species are associated with intervened forest within Mashpi in the Choco Biosphere Reserve. The secondary forest has the major sandflies' richness, while the primary forest exhibits the major abundance. INTERPRETATION CONCLUSION: The results indicated that Th. reburra is a sandfly restricted to the Andean Forest and is a bioindicator of the high environmental health quality of the forest, while Ny. trapidoi and Pa. aclydifera are bioindicators of environmental disturbances in the forest. Additionally, Ps. panamensis, Lu. hartmanni and Ny. trapidoi are bioindicators of human impact and the risk of leishmaniasis.

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Bovine mastitis is an emerging disease that causes large economic losses. Staphylococcus aureus its main etiological agent, is multi-resistant to antimicrobials and produces biofilm. The objective of this study was to investigate the effect of Agave fructans (AF), a type of prebiotic, on multi-resistant and biofilm-forming isolates of S. aureus. Ten isolates of S. aureus from bovine subclinical mastitis previously characterized as highly resistant to antimicrobials and biofilm formers were used in this study. The growth kinetics of S. aureus in the presence of AF was evaluated by the Baranyi and Roberts microbial growth model using the DMFit program. The antibacterial activity of AF against S. aureus was studied by the well-diffusion method and the effect on biofilm formation by the crystal violet method. All assays were performed in triplicate for each isolate and an ANOVA with Tukey's post hoc was performed considering p < 0.05 as significant. The AF showed a decrease in maximum growth rate (µmax) and OD max levels (Ymax) in all isolates with all concentrations. Also, zones of inhibition were observed due to the effect of all AF concentrations in all isolates in a dose-dependent manner. Interestingly, S. aureus biofilm formation was inhibited by all AF concentrations assessed in this study. More investigations are required to elucidate the mechanisms of action of AF on S. aureus as well as in vivo studies to evaluate its therapeutic efficacy for bovine mastitis.

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The Astyanax mexicanus complex includes two different morphs, a surface- and a cave-adapted ecotype, found at three mountain ranges in Northeastern Mexico: Sierra de El Abra, Sierra de Guatemala and Sierra de la Colmena (Micos). Since their discovery, multiple studies have attempted to characterize the timing and the number of events that gave rise to the evolution of these cave-adapted ecotypes. Here, using RADseq and genome-wide sequencing, we assessed the phylogenetic relationships, genetic structure and gene flow events between the cave and surface Astyanax mexicanus populations, to estimate the tempo and mode of evolution of the cave-adapted ecotypes. We also evaluated the body shape evolution across different cave lineages using geometric morphometrics to examine the role of phylogenetic signal versus environmental pressures. We found strong evidence of parallel evolution of cave-adapted ecotypes derived from two separate lineages of surface fish and hypothesize that there may be up to four independent invasions of caves from surface fish. Moreover, a strong congruence between the genetic structure and geographic distribution was observed across the cave populations, with the Sierra de Guatemala the region exhibiting most genetic drift among the cave populations analysed. Interestingly, we found no evidence of phylogenetic signal in body shape evolution, but we found support for parallel evolution in body shape across independent cave lineages, with cavefish from the Sierra de El Abra reflecting the most divergent morphology relative to surface and other cavefish populations.

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Cave-adapted animals provide a unique opportunity to study the evolutionary mechanisms underlying phenotypic, metabolic, behavioral, and genetic evolution in response to cave environments. The Mexican tetra ( Astyanax mexicanus) is considered a unique model system as it shows both surface and cave-dwelling morphs. To date, at least 33 different cave populations have been identified, with phylogenetic studies suggesting an origin from at least two independent surface lineages, thereby providing a unique opportunity to study parallel evolution. In the present study, we carried out the most exhaustive phylogeographic study of A. mexicanus to date, including cave and surface localities, using two mitochondrial markers (cytochrome b (cyt b) and cytochrome c oxidase subunit I ( COI)) and nuclear rhodopsin visual pigment ( rho). Additionally, we inferred the molecular evolution of rho within the two contrasting environments (cave and surface) and across three geographic regions (Sierra de El Abra, Sierra de Guatemala, and Micos). In total, 267 individuals were sequenced for the two mitochondrial fragments and 268 individuals were sequenced for the rho visual pigment from 22 cave and 46 surface populations. Phylogeographic results based on the mitochondrial data supported the two-lineage hypothesis, except for the Pachón and Chica caves, whose introgression has been largely documented. The Sierra de El Abra region depicted the largest genetic diversity, followed by the Sierra de Guatemala region. Regarding the phylogeographic patterns of rho, we recovered exclusive haplogroups for the Sierra de El Abra (Haplogroup I) and Sierra de Guatemala regions (Haplogroup IV). Moreover, a 544 bp deletion in the rho gene was observed in the Escondido cave population from Sierra de Guatemala, reducing the protein from seven to three intramembrane domains. This change may produce a loss-of-function (LOF) but requires further investigation. Regarding nonsynonymous ( dN) and synonymous ( dS) substitution rates (omega values ω), our results revealed the prevailing influence of purifying selection upon the rho pigment for both cave and surface populations (ω<1), but relaxation at the El Abra region. Notably, in contrast to the other two regions, we observed an increase in the number of dN mutations for Sierra de El Abra. However, given that a LOF was exclusively identified in the Sierra de Guatemala region, we cannot dismiss the possibility of a pleiotropic effect on the Rho protein.

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Automatic image description, also known as image captioning, aims to describe the elements included in an image and their relationships. This task involves two research fields: computer vision and natural language processing; thus, it has received much attention in computer science. In this review paper, we follow the Kitchenham review methodology to present the most relevant approaches to image description methodologies based on deep learning. We focused on works using convolutional neural networks (CNN) to extract the characteristics of images and recurrent neural networks (RNN) for automatic sentence generation. As a result, 53 research articles using the encoder-decoder approach were selected, focusing only on supervised learning. The main contributions of this systematic review are: (i) to describe the most relevant image description papers implementing an encoder-decoder approach from 2014 to 2022 and (ii) to determine the main architectures, datasets, and metrics that have been applied to image description.

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BACKGROUND: Ultraviolet B (UVB) causes photoaging of the skin, the appearance of wrinkles, spots, and alteration of the skin barrier. The main cells in the most superficial layer of the skin are the keratinocytes; these cells play an important role in protecting this organ. OBJECTIVE: The present study aimed to investigate the antioxidant activity of the hydrolysates from kafirin to inhibit UVB-induced responses in human keratinocytes cells (HaCaT). METHODS: Kafirin hydrolysates were produced by enzymatic hydrolysis with alcalase. The activity of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), in the HaCaT cell line in the presence of UVB and the effects of the hydrolysates against the UVB-induced response were evaluated. Furthermore, the peptides that were generated by hydrolysis were identified in silico using the BIOPEP database. RESULTS: Two protein sequences were identified (α-kafirin and the precursor protein of α-kafirin), in the kafirin extract. A degree of hydrolysis of 18.8% was obtained by hydrolyzing the kafirin extract with alcalase. The kafirin hydrolysates avoided the decrease in endogenous antioxidant enzymes such as SOD, CAT, and GPx reducing the oxidative stress generated by UVB. Using the BIOPEP-UWM database, we found 102 peptide sequences, and it has shown that the peptides have a large amount of hydrophobic amino acids such as proline, alanine, and glutamine, and amino acids with high antioxidant capacity. CONCLUSION: These results suggest that the kafirin hydrolysates can be used as antioxidant agents to ameliorate UVB-induced skin keratinocytes cells' response in vitro, providing an alternative against UVB-induced photoaging.

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Background: Patients who come to the emergency department are different from those seen in outpatient clinics. The former suffer greater stress. Aim: Establish an association between the attribution of the symptoms (psychosocial or organic) by the patient and the level of perceived stress in patients with Medically Unexplained Physical Symptoms (MUS) in an emergency department. Methods: A correlational cross-sectional study was conducted in 138 patients with MUS in the emergency department of a 3rd level public hospital where the psychosocial or organic attribution of nonspecific symptom(s) by patients and the perceived stress were measured with validated scales. Bivariate analysis was performed with Chi square for categorical variables, and a Spearman correlation, p <0.05. Results: 75% of patients with psychosocial attribution have higher stress compared to patients with organic symptom attribution (25%). In Spearman's correlation, a medium but statistically significant correlation was obtained. Conclusions: The psychosocial attribution of the patient's complaint might coexist in MUS patients with higher level of perceived stress by the patients. Health professionals might need to address both psychosocial attributions and stress in MUS patients.

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Allan-Herndon-Dudley syndrome is a rare X-linked genetic disorder, caused by a deficiency of the monocarboxylate transporter 8 (MCT8), a specific transporter of thyroid hormones, with functions mainly at the brain level. The syndrome produces an early onset of severe neurological disorder, in which hypotonia predominates. OBJECTIVE: To present a rare case with an unexpected diagnosis, highlighting the usefulness of requesting a complete thyroid profile in every hypotonic male infant without a specific cause. CLINICAL CASE: A 10-month-old male infant with severe axial and peripheral hypotonia, global weakness with little spontaneous mobility, without head support or stable sitting. Complete metabolic and peripheral neurophysiological studies were performed. Genetic studies for spinal muscular atrophy, Prader Willi syndrome, and myotonic dystrophy were also performed. The trio exome analysis detected a probably pathogenic variant c.359C>T;p.(Ser120Phe), hemizygous in exon 1 of the SLC16A2 gene, inherited from the mother. Thyroid abnormalities as increased free triiodothyronine (T3) and thyroid-stimulating hormone (TSH), and delayed myelination were ob served. CONCLUSIONS: MCT8 deficiency should be considered in the case of the male infant with unex plained hypotonia and weakness without a determined cause. The diagnosis is guided by a thyroid profile including free T3 hormone, because it presents a characteristic thyroid profile with decreased free thyroxine (T4), increased free T3, and normal or slightly elevated TSH levels. In this case, the implementation of the trio exome analysis allows establishing an early certain diagnosis.

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Non-alcoholic fatty liver disease (NAFLD) affects 20-25% of the general population and is associated with morbidity, increased mortality, and elevated health-care costs. Most NAFLD risk factors are modifiable and, therefore, potentially amenable to being reduced by public health policies. To date, there is no information about NAFLD-related public health policies in the Americas. In this study, we analysed data from 17 American countries and found that none have established national public health policies to decrease NAFLD-related burden. There is notable heterogeneity in the existence of public health policies to prevent NAFLD-related conditions. The most common public health policies were related to diabetes (15 [88%] countries), hypertension (14 [82%] countries), cardiovascular diseases (14 [82%] countries), obesity (nine [53%] countries), and dyslipidaemia (six [35%] of countries). Only seven (41%) countries had a registry of the burden of NAFLD, and efforts to raise awareness in the Americas were scarce. The implementation of public health policies are urgently needed in the Americas to decrease the burden of NAFLD.

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BACKGROUND: Postoperative symptoms and pain after laparoscopic cholecystectomy (LC) are common in women. However, there is no evidence of differences in incidence and severity among different age groups. We evaluated whether adverse postoperative symptoms were more common in younger than in older women after LC. METHODS: One hundred and fifty premenopausal (mean age 37.6 ± 3.6 y) and 145 postmenopausal women (59 ± 5.2 y) were included in this retrospective cohort study. Clinical and anthropometric parameters were analyzed. Study endpoints were the incidences of postoperative nausea and vomiting (PONV) and pain, and the additional analgesics and antiemetics needed after surgery. RESULTS: Body mass index was normal in 42.7% of patients in the younger group and 64.8% in the older group (P < 0.001). Reported pain was more frequent and intense in the younger group throughout the study period (P < 0.01). Additional narcotics were required in 18% of premenopausal versus 7.6% of postmenopausal women (P = 0.001), and the doses used to reduce pain were higher for premenopausal women (P = 0.02). PONV was more frequent in the younger group at 1 and 6 h after surgery (P < 0.005). Rescue antiemetics were required in 29 premenopausal and 13 postmenopausal women (P = 0.01). Hospital stay was shorter for the older patients (P = 0.01). Minor morbidity was observed in both groups (0.7% and 2.1%). There was no mortality. CONCLUSIONS: Early PONV and pain after LC were more frequent in premenopausal women, who also required more rescue analgesic and antiemetic medication.

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The endangered Chiapas killifish Tlaloc hildebrandi is an endemic freshwater species that lives in four subbasins of the Grijalva and Usumacinta basins, and one of the most geographically restricted species of the Produndulidae family. The species was originally described as endemic to springs in the high limestone plateau in San Cristóbal de Las Casas in the Río Amarillo subbasin (upper Grijalva basin). However, it was recently recorded in the Jataté and Tzaconejá subbasins in the upper Usumacinta basin, thereby expanding its known distribution range. The discovery of these populations is relevant not only for the conservation of the species but also for a better understanding of its evolutionary history. Currently, the scarce populations of T. hildebrandi, found in only a few localities in the Grijalva and Usumacinta basins, are fragmented and living under unfavorable conditions. Here, we analyzed three mitochondrial (mt-atp8&6 and mt-nd2) and one nuclear (nuc-s7) marker in order to assess the genetic diversity and population structure of T. hildebrandi. We found that, in comparison with other endangered freshwater fish species from Mexico, T. hildebrandi showed a lower level of genetic diversity (mt-nd2: h = 0.469, π = 0.0009; mt-atp8&6: h = 0.398, π = 0.001; and nuc-S7: h = 0.433, π = 0.001). Moreover, the analyzed populations exhibited a strong genetic structure in accordance with their geographic distribution, and can be placed into three genetic clusters: (1) Amarillo plus Chenhaló in the upper Grijalva basin, (2) Jataté, and (3) Tzaconejá, both in the upper Usumacinta basin. On the basis of our results, we propose the recognition of at least three evolutionarily significant units (ESUs) for the species and the urgent implementation of ex situ and in situ conservation and management efforts that consider the genetic background of the species.

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BACKGROUND: In Mexico, breast cancer is the leading cause of death by malignant tumors in women aged 20 and older. The World Health Organization estimates that 69% of deaths caused by breast cancer occur in developing countries. Little is known about the prevalence of breast carcinoma in Mexico and its molecular subclassification. METHODS: This retrospective cross-sectional study included patients who underwent a mastectomy (single, radical or lumpectomy) or a breast tumor biopsy (core-needle or excisional) from January 2002 to December 2018. The primary purpose of the study was to determine the prevalence and molecular profile of breast in comprehensive cancer center in Mexico and compare our results with those published in the US. This study was approved by our scientific and bioethical committee. RESULTS: The final analysis included 379 patients. The youngest patient was 23 years old and the oldest patient was 89; the mean age at diagnosis was 54.63 years. Patients of 40 years old or younger accounted for 48 of the cases (12.66%) and those older than 40 accounted for 331 of the cases (87.33%). The molecular subclassification showed luminal A subtype in 139 cases (36.67%), luminal B subtype in 143 cases (37.73%), human epidermal growth factor receptor 2-positive carcinomas in 32 cases (8.44%) and triple-negative carcinomas in 65 cases (17.15%). Diabetes mellitus was present in 43 patients (11.34%), hypertension in 78 patients (20.58%), obesity in 82 patients (21.63%) and 66 patients reported being treated with exogenous hormone therapy (17.41%). CONCLUSIONS: Breast carcinoma occurs at an earlier age in Mexican women compared to women in the US. Hormone-positive tumors were found to be more prevalent in older patients, while high-grade tumors were more frequently identified in younger patients.

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Identification of species involved in cadaveric decomposition, such as scavenger Diptera, is a fundamental step for the use of entomological evidence in court. Identification based on morphology is widely used in forensic cases; however, taxonomic knowledge of scavenger fauna is poor for many groups and for many countries, particularly Neotropical ones. A number of studies have documented the utility of a DNA barcoding strategy to assist in the identification of poorly known and diverse groups, particularly in cases involving immature states or fragmented organisms. To provide baseline knowledge of the diversity of scavenger Diptera in the Valley of Mexico, we generated a DNA barcode collection comprised of sequences of the cytochrome c oxidase subunit 1 (COI) gene for all families sampled at a nature reserve located in this region. We collected and identified specimens on the basis of morphology and a species delimitation analysis. Our analyses of 339 individuals delineated 42 species distributed across nine families of Diptera. The richest families were Calliphoridae (9 species), Sarcophagidae (7 species), and Phoridae (6 species). We found many of the species previously recorded for the Valley of Mexico, plus 18 new records for the region. Our study highlights the utility of DNA barcoding as a first-step strategy to assess species richness of poorly studied scavenger fly taxa.

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INTRODUCCIÓN: Las zoonosis son enfermedades compartidas entre animales vertebrados y humanos. La secuencia de transmisión comienza con la exposición del humano a elementos infectivos en el ambiente. Muchas patologías mantienen su reservorio en la población canina. Según estudios previos en la región, un 47% de las muestras de heces caninas ambientales (HCA) recolectadas en plazas y paseos públicos contenían al menos una especie parasitaria. El objetivo del trabajo fue actualizar la frecuencia de aparición de parásitos de importancia zoonótica en HCA recogidas en plazas de dos barrios costeros de la ciudad de Comodoro Rivadavia (Chubut) entre marzo y diciembre de 2018. MÉTODOS: Se realizó un estudio observacional, descriptivo y transversal en Caleta Córdova (BCC) y Stella Maris (BSM), donde se recolectaron por conglomerados en forma de guarda griega, aleatoria y sistemática, 156 muestras de HCA. RESULTADOS: Se concentraron y observaron muestras al microscopio, resultando positivas para parásitos 83%; 63% presentó más de un género parasitario. Se destacaron 15 géneros con capacidad para infectar al humano. Los parásitos más abundantes fueron Toxocara spp. y Blastocystis spp. en BCC y Toxocara spp. y Giardia spp. en BSM. En BCC se reportó Mesostephanus spp. por primera vez en Argentina. DISCUSIÓN: Es necesario dimensionar la contaminación ambiental por parásitos zoonóticos, a fin de implementar intervenciones de salud pública adecuadas a cada escenario y contexto epidemiológico.

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Blue mussels (Mytilus edulis) are among the most consumed fishery products globally. Foodborne outbreaks of mussel-associated infections by viral, bacterial, and parasitic pathogens have been reported in the last years. In this study, we investigated the occurrence, genetic diversity, and zoonotic potential of the diarrhea-causing enteric protozoan Giardia duodenalis in blue mussels from Caleta Córdova in Chubut Province, southeast Patagonia, Argentina. A total of 344 free-living blue mussels were collected and distributed in 53 aliquots of pooled mussel tissue (each containing 5‒7 specimens) during the period 2015‒2018. Conventional optical microscopy was used as screening method for the detection of G. duodenalis cysts in pooled, homogenized tissues. Samples with a positive result were assessed by a multilocus sequence genotyping scheme based on the amplification of partial fragments of the glutamate dehydrogenase and ß-giardin genes of the parasite. G. duodenalis cysts were found in 30.2% (16/53) of the aliquots of pooled mussel tissue tested. PCR and sequencing analyses revealed the presence of G. duodenalis subassemblage BIV in selected aliquots. To the best of our knowledge, this is the first description of zoonotic subassemblage BIV from blue mussels in Argentina.

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Antecedentes: Las recomendaciones de esquemas para erradicar Helicobacter pylori se encuentran ampliamente dis- ponibles. Este es un patógeno de alta prioridad para búsqueda y desarrollo de nuevos y efectivos tratamientos. Objetivo: Descri- bir la respuesta terapéutica con terapia de rescate para infección por H. pylori, Hospital Escuela, Tegucigalpa, diciembre 2016-abril 2017. Métodos: Estudio descriptivo longitudinal retrospectivo en pacientes consecutivos con sintomatología gastrointestinal e in- fección conirmada por H. pylori. Mediante el registro del Servi- cio de Gastroenterología, Departamento de Medicina Interna, se identiicaron pacientes positivos por H. pylori. Se registraron datos sociodemográicos, clínicos y diagnósticos. El tratamiento de res- cate brindado fue, vía oral por 10 días: levoloxacina 500 mg/día, esomeprazol 40 mg dos veces/día, amoxicilina 1 gr dos veces/ día. La conirmación de la erradicación fue realizada 4-8 semanas postratamiento. Se registró información sobre la adherencia al tra- tamiento y los efectos secundarios. Resultados: Se analizaron 30 casos; 56.7% (17) pacientes nuevos y 43.3% (13) pacientes con al menos un fracaso. En el 16.0% (5) no hubo conirmación de erra- dicación; se obtuvo una tasa de erradicación del 72.0% (18/25), IC95% 50.6-87.9; siendo 78.5% (11/14) en pacientes nuevos ver- sus 63.6% (7/11) en fracasos previos, IC95% -9.6-54.0, p=0.318. Discusión: La tasa de erradicación en este grupo de pacientes no fue satisfactoria. Actualmente el tratamiento con levoloxacina es recomendado como terapia de segunda línea o de rescate en regiones con baja o alta resistencia a la claritromicina, aunque la resistencia a quinolonas ha aumentado en los últimos años en va- rios países...(AU)

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Antecedentes: La hemorragia gastrointestinal oculta representa aproximadamente del 5%-10% del total de las hemorragias digestivas. Descripción del caso clínico: Paciente femenina de 62 años, procedente de Santa Cruz de Yojoa, Cortés, sin comorbilidades, con episodios intermitentes de melena de un año de evolución; evaluada y manejada con hierro parenteral y transfusiones sanguíneas. Se le realizó protocolo diagnóstico, sin encontrar origen del sangrado. Fue sometida a laparoscopía diagnóstica en junio del 2019, realizándole apendicectomía, resección yeyunal, colecistectomía y ooforectomía; cursando asintomática luego de la cirugía. En diciembre, reinicia con melena, 3-4 episodios diarios, abundante cantidad (aproximadamente 300 ml). Evaluada nuevamente sin lograr identificar el origen del sangrado, por lo cual se realizó vídeo capsula endoscópica que reportó, restos hemáticos sin observar sitio de sangrado. Se llevó a cabo enteroscopía de empuje y duodenoscopía observando sitio de sangrado cercano a la papila duodenal. Se decide realizar angiotomografía, la cual fue compatible con sangrado digestivo a nivel de la II y III porción del duodeno. Luego se efectúa arteriografía selectiva de vasos abdominales, evidenciando fuga de medio de contraste originada en la rama de la arteria hepática derecha de origen en la mesentérica superior. Finalmente se procedió a la aplicación de 2 hemoclip vía endoscópica obteniendo un resultado satisfactorio.Conclusiones: El tipo de lesión responsable de la hemorragia del intestino delgado depende de la edad del paciente. Los factores de riesgo de hemorragia recurrente por angioectasia incluyen el número de lesiones, la edad avanzada, comorbilidades y la terapia anticoagulante...(AU)

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