RESUMO
A 15-year-old male patient presented with dysphagia, regurgitation, weight loss and retrosternal pain. The diagnosis of achalasia was made 4 years before. The esophagogram revealed severe esophagus dilatation and the classic "bird-beak" termination. A Heller myotomy plus fundoplication and endoscopic balloon dilatation were conducted four months previously. Nevertheless, the symptoms persisted and the last high-resolution manometry study still showed achalasia type II. The patient underwent a peroral endoscopic esophageal myotomy (POEM). POEM is a feasible and safe procedure for experienced and properly-equipped health care delivery centers and could be used as a rescue treatment in refractory achalasia. We present the youngest patient with achalasia in our region who had a successful response to rescue POEM.
Assuntos
Acalasia Esofágica , Miotomia de Heller , Cirurgia Endoscópica por Orifício Natural , Adolescente , Criança , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Fundoplicatura , Humanos , Masculino , Resultado do TratamentoRESUMO
A 15-year-old male patient presented with dysphagia, regurgitation, weight loss and retrosternal pain. The diagnosis of achalasia was made 4 years before. The esophagogram revealed severe esophagus dilatation and the classic "bird-beak" termination. A Heller myotomy plus fundoplication and endoscopic balloon dilatation were conducted four months previously. Nevertheless, the symptoms persisted and the last high-resolution manometry study still showed achalasia type II. The patient underwent a peroral endoscopic esophageal myotomy (POEM). POEM is a feasible and safe procedure for experienced and properly- equipped health care delivery centers and could be used as a rescue treatment in refractory achalasia. We present the youngest patient with achalasia in our region who had a successful response to rescue POEM.
Un paciente varón de 15 años, con el diagnóstico de acalasia realizado 4 años antes, acudió a evaluación por presentar disfagia, regurgitación, pérdida de peso y dolor restroesternal. El esofagograma baritado evidenció una dilatación severa del esófago y la terminación clásica en "pico de pájaro". El paciente había sido sometido a una miotomía de Heller más fundoplicatura y posteriormente a una dilatación esofágica con balón 4 meses atrás. Sin embargo, los síntomas persistían y la última manometría de alta resolución reveló acalasia tipo II. Finalmente, se realizó una miotomía endoscópica por vía oral (POEM); el cual es un procedimiento seguro y accesible en centros experimentados y debidamente equipados, pudiendo ser una adecuada opción de tratamiento en casos de acalasia refractaria. Presentamos el caso del paciente más joven en nuestra región con acalasia con una respuesta exitosa a un POEM de rescate.
RESUMO
INTRODUCTION: During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. OBJECTIVE: The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. MATERIALS AND METHODS: We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. RESULTS: With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer during the pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. CONCLUSION: The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.
Assuntos
Infecções por Coronavirus , Endoscopia Gastrointestinal/tendências , Hemorragia Gastrointestinal/diagnóstico por imagem , Pandemias , Pneumonia Viral , Padrões de Prática Médica/tendências , Tempo para o Tratamento/tendências , Trato Gastrointestinal Superior/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Tomada de Decisão Clínica , Infecções por Coronavirus/prevenção & controle , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Mortalidade Hospitalar/tendências , Humanos , Controle de Infecções/métodos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Peru , Pneumonia Viral/prevenção & controle , Estudos RetrospectivosRESUMO
ABSTRACT Introduction : During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. Objective : The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. Materials and methods : We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. Results : With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer during the pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. Conclusion : The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.
RESUMEN Introducción : Durante la pandemia de COVID-19, los procedimientos endoscópicos se asocian con un alto riesgo de infección por SARS-CoV-2. Sin embargo, en casos de hemorragia digestiva alta (HDA), se debe dar prioridad a una endoscopia precoz. Objetivo : El objetivo principal fue comparar el tiempo transcurrido desde la llegada al hospital y la realización de la endoscopia entre ambos grupos. Materiales y métodos : Realizamos un estudio retrospectivo. Los datos contienen información de pacientes que acudieron al hospital con HDA y fueron sometidos a endoscopia entre el 19 de octubre de 2019 y el 6 de junio de 2020. Los pacientes se dividieron en 2 fases: prepandémica y pandémica. Se comparó el tiempo transcurrido entre la llegada al hospital y la realización de la endoscopia en ambas fases, así como otros indicadores como la estancia hospitalaria y la mortalidad intrahospitalaria. Resultados : Con información de 219 pacientes, la mediana de edad fue de 69 años. Se realizaron 154 y 65 endoscopias en fase prepandémica y pandémica, respectivamente. El tiempo entre la llegada al hospital y la realización de la endoscopia fue significativamente mayor durante la pandemia (10,00 frente a 13,08 horas, valor de p = 0,019). Sin embargo, no hubo diferencias significativas en la estancia hospitalaria ni en la mortalidad. Conclusión : El manejo de pacientes con HDA durante la pandemia de COVID-19 es complejo y requiere la aplicación del juicio clínico para decidir el mejor momento para realizar una endoscopia sin afectar la atención del paciente.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral , Padrões de Prática Médica/tendências , Endoscopia Gastrointestinal/tendências , Infecções por Coronavirus , Trato Gastrointestinal Superior/diagnóstico por imagem , Pandemias , Tempo para o Tratamento/tendências , Hemorragia Gastrointestinal/diagnóstico por imagem , Peru , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos , Controle de Infecções/métodos , Mortalidade Hospitalar/tendências , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Tomada de Decisão Clínica , COVID-19 , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Tempo de Internação/tendênciasRESUMO
Introducción: La violencia contra la mujer es un problema de salud pública que juega un rol determinante en la salud. Los acelerados cambios económicos per cápita conducen al ascenso del poblador peruano en los quintiles de riqueza, pero no otorgarán un desarrollo psico-socio-cultural con la misma celeridad. Se plantea que pertenecer a un mayor nivel de riqueza no garantiza la disminución de maltrato hacia la mujer. Material y Métodos: Se utilizó los datos de la Encuesta Demográfica y de Salud Familiar (ENDES) 2013. Participaron las mujeres entre 15-49 años que informaron tener o haber tenido una pareja y que respondieran al módulo de violencia doméstica. Se analizó en el programa SPSS v.20, las pruebas univariadas, bivariadas, con Chi-cuadrado y DR, y finalmente un análisis de regresión logística binaria. Resultados: La prevalencia de violencia global fue de 44,5 por ciento. La frecuencia de violencia psicológica, física y sexual fue de 30,3 por ciento, 36,8 por ciento, y 8,6 por ciento, respectivamente. Los factores que se hallaron significativos fueron, de la pareja: no contar con educación superior, consumo de alcohol, control de relaciones con otros; de la mujer: ser testigo de violencia doméstica en la infancia, quintil de riqueza de pobreza o pobreza extrema y residir en zona urbana. Conclusión: Un bajo nivel de riqueza se asocia a la presencia de violencia ejercida contra la mujer en relación de pareja.
Introduction: Violence against women is a public health problem that plays a key role in health. The rapid economic changes lead to the rise in wealth index of Peruvian population, but not award a socio-psycho-cultural development with the same speed. We argues that belong to a higher level of wealth does not guarantee the reduction of abuse against women. Material and Methods: Data from the ENDES (Encuesta Demográfica y de Salud Familiar) 2013. The participants were women between 15-49 years old who reported having or having had a partner, and to respond the domestic violence module. It was analyzed in SPSS v.20 program, first univariate tests, then bivariate tests with chi-square and OR, and finally a binary logistic regression analysis. Results: The prevalence of violence was 44.5 per cent. The frequency of psychological, physical and sexual violence was 30.3 per cent, 36.8 per cent and 8.6 per cent, respectively. The factors that were found significant, about the couple: not having higher education, alcohol consumption, control relationships with others; about woman: witnessing domestic violence in childhood, wealth index at poverty or extreme poverty and reside in urban areas. Conclusion: A low level of wealth index is associated with the presence of partner violence against women.
Assuntos
Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Cônjuges , Delitos Sexuais , Fatores Socioeconômicos , Parceiros Sexuais , Violência Doméstica , Violência contra a Mulher , Estudos Observacionais como Assunto , Estudos TransversaisRESUMO
Introducción: La hoja de coca ha sido usada tradicionalmente con fines medicinales y contiene altos niveles de hierro. Objetivos: Determinar el efecto del extracto etanólico de Erythroxylum coca spp. frente a anemia ferropénica inducida por dieta deficiente en hierro, en ratas Holtzman macho. Diseño: Experimental. Lugar: Laboratorio del Instituto de Patología, Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Material biológico: Dieciocho ratas Holtzman macho de 16 días de edad recién destetadas. Intervenciones: Se formó tres grupos de seis ratas cada uno: a) grupo hierro suficiente (HS), recibió 25 g/d de alimento balanceado durante 7 semanas; b) grupo hierro deficiente (HD), recibió 25 g/d de dieta ferropénica durante 7 semanas; y, c) el grupo hierro deficiente - extracto E. coca (HD-EC), recibió 25 g/d de dieta ferropénica durante 7 semanas y a partir de la semana 5 se agregó 18 g/d de extracto de E. coca. Principales medidas de resultados: Nivel sérico de hemoglobina, peso y talla. Resultados: Al finalizar el tratamiento, se observó aumento significativo de la hemoglobina en el grupo HD-EC (p=0,04). Se encontró diferencia significativa en los niveles séricos de hemoglobina entre los grupos HD-EC y HD (p=0,0062). No se encontró diferencia significativa en los valores de hemoglobina entre los grupos HD-EC y HS (p= 0,06). No se evidenció diferencia en el peso y la talla entre los grupos HD y HD-EC (p=0,20 y p=0,23, respectivamente). Conclusiones: E. coca presenta efecto antianémico experimental, sustentado en los resultados de los niveles de hemoglobina.
Introduction: Coca leaf has been traditionally used for medical purposes and contains high iron levels. Objective: To determine the effect of Erythroxylum coca spp. ethanol extract in iron-deficiency anemia induced by iron-deficient diet in male Holtzman rats. Design: Experimental. Setting: Institute of Pathology Laboratory, Universidad Nacional Mayor de San Marcos. Biologic material: Eighteen weaned male Holtzman rats 16 days old. Interventions: Rats were allocated to three groups of six rats each: a) iron-sufficient group (IS) received 25 g/d of balanced diet for 7 weeks; b) iron-deficient group (ID) received 25 g/d of iron-deficient diet for 7 weeks; and, c) iron deficient/E. coca extract group (ID-CE) received 25 g/d of iron-deficient diet for 7 weeks, and in the fifth week 18 g/d of E. coca extract were added. Main outcome measures: Serum hemoglobin level, weight and height. Results: At the end of the treatment, there was significant difference of hemoglobin in the ID-CE group (p=0.04). There was significant difference in serum hemoglobin levels between ID-CE and ID groups (p=0.0062). No significant difference was found in serum hemoglobin levels between ID-CE and IS groups (p=0.06). No significant difference was found in weight and height between ID and ID-CE groups (p=0.20 and p=0.23, respectively). Conclusions: E. coca had experimental antianemic effect supported by findings in the serum hemoglobin levels.