RESUMO
Introduction: The pandemic had a profound impact on the provision of health services in Cúcuta, Colombia where the neighbourhood-level risk of Covid-19 has not been investigated. Identifying the sociodemographic and environmental risk factors of Covid-19 in large cities is key to better estimate its morbidity risk and support health strategies targeting specific suburban areas. This study aims to identify the risk factors associated with the risk of Covid-19 in Cúcuta considering inter -spatial and temporal variations of the disease in the city's neighbourhoods between 2020 and 2022. Methods: Age-adjusted rate of Covid-19 were calculated in each Cúcuta neighbourhood and each quarter between 2020 and 2022. A hierarchical spatial Bayesian model was used to estimate the risk of Covid-19 adjusting for socioenvironmental factors per neighbourhood across the study period. Two spatiotemporal specifications were compared (a nonparametric temporal trend; with and without space-time interaction). The posterior mean of the spatial and spatiotemporal effects was used to map the Covid-19 risk. Results: There were 65,949 Covid-19 cases in the study period with a varying standardized Covid-19 rate that peaked in October-December 2020 and April-June 2021. Both models identified an association of the poverty and stringency indexes, education level and PM10 with Covid-19 although the best fit model with a space-time interaction estimated a strong association with the number of high-traffic roads only. The highest risk of Covid-19 was found in neighbourhoods in west, central, and east Cúcuta. Conclusions: The number of high-traffic roads is the most important risk factor of Covid-19 infection in Cucuta. This indicator of mobility and connectivity overrules other socioenvironmental factors when Bayesian models include a space-time interaction. Bayesian spatial models are important tools to identify significant determinants of Covid-19 and identifying at-risk neighbourhoods in large cities. Further research is needed to establish causal links between these factors and Covid-19.
RESUMO
INTRODUCTION AND AIMS: The patency capsule is an effective diagnostic method for preventing video capsule retention in the small bowel during capsule endoscopy. The most frequently associated complication when using the patency capsule is symptomatic retention. The aim of the present study was to evaluate the effectiveness and safety of patency capsules administered to patients at a tertiary care hospital center. MATERIALS AND METHODS: A retrospective observational study was conducted that included all the patients with confirmed Crohn's disease that were administered a patency capsule, within the time frame of January 2019 and December 2020. PC diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value were evaluated, in relation to capsule endoscopy and double-balloon endoscopy findings. Complications associated with the patency capsule were also identified. RESULTS: Thirty patients were included, in whom the patency capsule had 83% sensitivity, 100% specificity, 100% positive predictive value, and 96% negative predictive value, with a diagnostic yield of 96.7%. There was one complication (3.3%) and it resolved spontaneously. CONCLUSIONS: The patency capsule is a safe and effective method for reducing video capsule retention during capsule endoscopy in patients with Crohn's disease.
Assuntos
Endoscopia por Cápsula , Doença de Crohn , Humanos , Doença de Crohn/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Endoscopia por Cápsula/efeitos adversos , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
Background and study aims: Small-bowel capsule endoscopy (SBCE) is a safe and efficient method for diagnosis of small-bowel diseases. Since its development, different models have appeared. The aim of this study was to analyze which of the different models of SBCE has the best diagnostic yield. Patients and methods: Extensive medical literature research was reviewed, using MESH terms, searching studies comparing different SBCE types. We analyzed the diagnostic yield of all the comparisons and when there were 2 or more studies that compared the same model of SBCEs, a meta-analysis was performed. Results: Ten eligible studies including 1065 SBCEs procedures were identified. The main indication was occult gastrointestinal bleeding in 9/10 studies. Two of them included anemia, chronic diarrhea and/or chronic abdominal pain. The indication in one article was celiac disease. In 9 studies, different types of SBCEs (MiroCam, Endocapsule, OMOM and CapsoCam) were compared with PillCam (SB, SB2 and SB3). Three studies compared MiroCam vs PillCam and CapsoCam vs PillCam, while two studies contrast Endocapsule vs PillCam. None of the SBCEs show superiority over PillCam [OR 0.78 (95%CI;0.60-1.01)]. One study compared SBCEs other than Pillcam (MiroCam vs Endocapsule). Nine studies did not find statistical differences between SBCEs, one showed better diagnostic yield of Mirocam compared with PillCam SB3 (p=0.02). The difference between these SBCE was not replayed in the metaanalysis [OR 0.77 (95%CI;0.49-1.21)]. Conclusions: Despite the appearance of new SBCE models, there are no differences in diagnostic yield; therefore, SBCE endoscopist's performance should be based on experience and availability.
Assuntos
Endoscopia por Cápsula , Doença Celíaca , Enteropatias , Endoscopia por Cápsula/métodos , Doença Celíaca/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Humanos , Enteropatias/diagnóstico , Intestino DelgadoRESUMO
INTRODUCTION AND AIM: Graft-versus-host disease (GvHD) is a complication of hematopoietic cell transplantation, and the small bowel is one of the main targets in the gastrointestinal tract. Capsule endoscopy is a safe procedure and can be useful in the diagnosis of GvHD. The aim of the present study was to compare the diagnostic yield of capsule endoscopy with the histopathologic findings in GvHD. MATERIALS AND METHODS: A retrospective diagnostic test study included all the patients with suspected GvHD that underwent gastroscopy and colonoscopy, with histopathologic evaluation of the biopsies taken, and capsule endoscopy, within the time frame of July 2015 and July 2019. Capsule endoscopy findings were compared with the histopathologic diagnosis, considered the gold standard. RESULTS: Twenty-one patients with GvHD (7 [33%] women; 37 ± 11.9 years of age) were included, 20 (95%) of whom had acute GvHD. The median gastric transit time of the capsule was 55 minutes (20-113) and the median small bowel transit time was 261 minutes (238-434). The entire small bowel was visualized through capsule endoscopy in 17 cases (80.95%). The histopathologic findings and capsule endoscopy findings resulted in the diagnosis of GvHD in 17 and 16 cases, respectively. There was agreement between the histopathologic and capsule endoscopy findings in 18 cases (15 positive and 3 negative). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic yield of capsule endoscopy were 88%, 75%, 94%, 60%, and 85%, respectively. CONCLUSIONS: Capsule endoscopy is a safe tool for the diagnosis of GvHD, with high sensitivity and positive predictive value, as well as moderate agreement with histopathologic findings.
Assuntos
Endoscopia por Cápsula , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Feminino , Doença Enxerto-Hospedeiro/diagnóstico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Intestino Delgado/diagnóstico por imagem , Estudos RetrospectivosRESUMO
INTRODUCTION: Appearing in the year 2000, capsule endoscopy revolutionized the study of the small bowel. It is the gold standard for the study of small bowel bleeding and is considered a safe procedure. OBJECTIVE: The aim of the present study was to identify the indications for, diagnostic yield, and safety of capsule endoscopy in Mexican patients. MATERIALS AND METHODS: A descriptive study was conducted on the first 500 small bowel capsule endoscopies performed at a tertiary care hospital center in Mexico City. Sex, age, type of video camera employed, bowel transit time, referral diagnosis, and capsule endoscopy findings and complications were registered. RESULTS: Mean patient age was 55years (±17.63) and 57.9% of the cases were women. Complete visualization of the small bowel was achieved in 420 capsule endoscopies (84%). Mean bowel transit time was 272.25minutes (±114.86). The most common indications for the procedure were small bowel bleeding (65.2%), search for neoplasia (14.4%), and Crohn's disease (10.2%). The presence of ulcers was the most common finding in small bowel bleeding (24.8%), followed by angioectasias (18.9%). Capsule retention was the only complication and it presented in 11 patients (2.2%). CONCLUSIONS: Capsule endoscopy is a safe and efficacious method for studying the small bowel. The results obtained in Mexican patients were similar to those described in the international literature. The present case series is the largest reported in a Mexican population.
Assuntos
Endoscopia por Cápsula , Enteropatias/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto JovemRESUMO
INTRODUCTION AND AIMS: Achalasia is characterized by incomplete relaxation of the lower esophageal sphincter and esophageal aperistalsis. The efficacy of peroral endoscopic myotomy (POEM) is similar to that of the Heller myotomy, with an apparently greater prevalence of gastroesophageal reflux disease. Our aim was to determine the presence of GERD in a post-POEM cohort of Mexican patients with achalasia and follow-up of at least 12 months. MATERIALS AND METHODS: A retrospective cohort study was conducted on post-POEM patients with a minimum of 12 months of follow-up, within the time frame of 2012 to 2017. Pregnant patients were excluded. Serial endoscopy, pH study, and GERDQ application were performed. Univariate and bivariate data analyses were carried out and statistical significance was set at a P<0.05. RESULTS: Sixty-eight patients had post-POEM follow-up for 12 months. Of those patients, follow-up continued to 24 months for 58, 36 months for 47, 48 months for 39, and 60 months for 25. Mean patient age was 47.8±14.3 years, 57.3% of the patients were women, 77.9% were treatment-naïve, and 54.4% had type II achalasia. The pH study, endoscopy, and questionnaire were positive in 73, 28, and 18% at 3 months; 48, 35, and 13% at 6 months, and 55, 30, and 15% at 12 months, respectively. Once the proton pump inhibitor was begun, the percentages decreased to 5, 2, and 6% at 24 months; 6, 2, and 8% at 36 months; 4,1, and 6% at 48 months; and 3, 1, and 4% at 60 months, respectively. There was no relation between the efficacy of POEM and the presence or intensity of GERD. There were no secondary complications due to gastroesophageal reflux. CONCLUSIONS: The post-POEM prevalence of GERD was 50% in the short term (12 months), with no evidence of complications at the medium term or long term (60 months). Gastroesophageal reflux was adequately controlled through proton pump inhibitors administration in over 95% of the cases.
Assuntos
Acalasia Esofágica/cirurgia , Refluxo Gastroesofágico/etiologia , Complicações Pós-Operatórias , Piloromiotomia , Adulto , Idoso , Feminino , Seguimentos , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Prevalência , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION AND OBJECTIVE: The SB3 capsule endoscopy system has better image resolution and the capacity to increase the number of images from 2 to 6 frames per second. Small bowel bleeding is the most common indication. The aim To determine if the advances in capsule endoscopy technology increase diagnostic yield in cases of small bowel bleeding, according to the Saurin classification. MATERIAL AND METHODS: A retrospective, observational, analytic, cross-sectional study included 100 SB2 capsule endoscopies and 100 SB3 capsule endoscopies in patients that presented with small bowel bleeding. The findings obtained with both systems were evaluated. The lesions identified by the two capsules were categorized using the Saurin classification. The relation between the lesions identified with the SB3 and those found with the SB2 was identified through a logistic regression analysis. RESULTS: In the SB2 capsule endoscopy group, 60% were women, patient age was 59 years (42.2, 73), and intestinal transit time was 271min (182, 353). In the SB3 group, 57% were women, patient age was 60 years (42.5, 73), and intestinal transit time was 277min (182, 352). There were no significant differences in the identification of P0 and P2 lesions between the two systems. The SB3 capsule endoscope identified more P1 lesions (p=0.020, OR: 2.35, 95% CI:1.12-4.90). There was no significant difference in relation to location of the lesions in the small bowel. CONCLUSIONS: A greater number of P1 lesions were detected through the technologic advances made in SB3 capsule endoscopy, but the diagnostic yield for P2 lesions was not modified.
Assuntos
Cápsulas Endoscópicas , Hemorragia Gastrointestinal/patologia , Intestino Delgado , Adulto , Idoso , Estudos Transversais , Desenho de Equipamento , Feminino , Humanos , Invenções , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCTION AND AIMS: Achalasia is characterized by the absence of lower esophageal sphincter relaxation and esophageal aperistalsis. Diagnosis is confirmed through high-resolution esophageal manometry. Laparoscopic myotomy is the standard treatment, but peroral endoscopic myotomy (POEM) is a safe and effective alternative, with good short-term and medium-term results. Our aim was to describe the short-term and medium-term experience with POEM at a tertiary care center. MATERIALS AND METHODS: The study was conducted within the time frame of November 2014 and February 2017. Treatment-naïve achalasia patients and previously-treated achalasia patients that were candidates for POEM were included. A protocolized 24-month follow-up was carried out. RESULTS: Fifty procedures were included and 31 (68%) were performed on women. Forty-one (82%) of the procedures were carried out on previously untreated patients, 7 (14%) were performed on previously treated patients, and 2 (4%) of the patients had redo-POEM. The mean age of the patients was 48.8±14.1 years. The pre-POEM Eckardt score was 9 and the integrated relaxation pressure was 24.4mmHg. Sixty-eight percent of the patients had type ii achalasia. Procedure time was 80min and myotomy length was 12.6cm. Hospital stay was 3 days and subcutaneous emphysema was the most common adverse event (30%). A total of 22/50 (44%) patients reached the 24-month follow-up, maintaining the Eckardt score and the decrease in the integrated relaxation pressure. There were no deaths. A total of 47.5% of the patients had a positive pH-study at 6 months, 15% had clinical reflux, and 35% presented with mild esophagitis. All the patients were adequately controlled with proton pump inhibitors. CONCLUSION: POEM is safe and effective in the short term and medium term for the treatment of achalasia and other esophageal motor disorders in Mexican patients.
Assuntos
Acalasia Esofágica/cirurgia , Transtornos da Motilidade Esofágica/cirurgia , Miotomia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
Resumen Introducción y objetivos: el análisis de la impedancia basal nocturna media (IBNM) se ha propuesto para incrementar la precisión diagnóstica de enfermedad por reflujo erosiva (ERGE). Nuestro objetivo fue evaluar el rendimiento diagnóstico de esta prueba en un grupo de pacientes con ERGE conocida. Materiales y métodos: incluimos 123 individuos (58 con ERGE y 65 controles sanos) a quienes se les realizó pH-impedanciometría (pH-IMM) consecutiva entre enero de 2015 y junio de 2017. Todos los pacientes tenían endoscopia tomada en los 6 meses previos. El tiempo de exposición ácida (TEA) anormal (>4,2%) y la presencia de pirosis y/o regurgitación en los 6 meses previos fueron los criterios para el diagnóstico de ERGE. Se encontraron 58 pacientes con ERGE, 24 con enfermedad por reflujo erosiva (ERE) y 34 con enfermedad por reflujo no erosiva (ERNE). Los 65 restantes fueron controles sanos (CS) asintomáticos con EGD y pH-IMM normales. Todos los trazos de pH-IMM se reanalizaron para medir la IBNM por un segundo observador que desconocía los datos previos. El análisis estadístico incluyó pruebas múltiples de Bonferroni para comparar los grupos; regresión lineal para variables continuas; y análisis de curva ROC para buscar valor IBNM con mayor rendimiento. Para los diferentes parámetros de precisión diagnóstica se utilizó el punto de corte de la IBNM. Se usó significancia estadística con valor de p <0,01 e intervalos de confianza de 95% (IC 95%) para todos los cálculos. Resultados: los pacientes con ERE y ERNE presentaron valores de IBNM significativamente más bajos que el grupo control (p <0,01). Se observó una correlación negativa entre los valores de la IBNM y TEA (r = 0,59; p = <0,001), y también entre la IBNM y número de eventos de reflujo (r = 0,37; p = <0,001). En el análisis de curva ROC, el área bajo la curva de la IBNM fue de 0,941 (IC 95%: 0,894-0,987) y el punto de corte con mayor eficiencia 1102 ohms (sensibilidad 98,5%; especificidad 84,5%). Usando este valor (<1,102), la IBNM tuvo una sensibilidad para detectar ERGE de 91% (ERNE 86% y ERE 100%) y una especificidad de 98%. Conclusión: la IBNM tiene alta sensibilidad y especificidad para el diagnóstico de la ERGE. Adicionar esta prueba al análisis convencional de la pH-impedancia y a los métodos actuales de estudio de la ERGE puede mejorar significativamente nuestra capacidad para diagnosticar la enfermedad.
Abstract Introduction and Objectives: Analysis of nocturnal basal impedance (IBNM) has been proposed as a way to increase accuracy of GERD diagnosis. Our objective was to evaluate the diagnostic performance of this test in a group of patients known to have GERD. Materials and methods: We included 123 individuals: 58 with GERD and 65 healthy controls. They underwent consecutive pH-impedance monitoring between January 2015 and June 2017. All had undergone endoscopy in the 6 months prior to testing. Criteria used for diagnosis of GERD were abnormal acid exposure time (AET > 4.2%), pyrosis and/or regurgitation in the previous 6 months. We found 58 patients with GERD of whom 24 had erosive reflux disease (ERE) and 34 had non-erosive reflux disease (NERD). The remaining 65 were asymptomatic healthy controls with normal endoscopic results and pH impedance monitoring. A second observer who did not know the previous data measurements analyzed all pH impedance monitoring traces for IBMN. Statistical analysis included multiple Bonferroni tests for comparison between groups, linear regression for continuous variables, and receiver operating characteristic (ROC) curve analysis to find high performance IBNM values. The IBNM cutoff point was used for diagnostic precision parameters. Statistical significance was set at p <0.01, and 95% confidence intervals were used for all calculations. Results: IBNM measures were significantly lower for patients with ERE and NERD than for the control group (p <0.01). A negative correlation was observed between IBNM and acid exposure time values (r = 0.59, p = <0.001) and also between IBNM and number of reflux events (r = 0.37, p = <0.001). ROC curve analysis found that the area under the curve for IBNM was 0.941 (95% CI: 0.894-0.987), and the cutoff point with the highest efficiency was 1,102 ohms (sensitivity 98.5%, specificity 84.5%). Using this value (<1.102), the IBNM had a sensitivity for detecting GERD of 91% (NERD 86% and ERE 100%) and a specificity of 98%. Conclusion: IBNM has high sensitivity and specificity for diagnosis of GERD. Addition of this test to conventional pH-impedance analysis and current methods for studying GERD can significantly improve our ability to diagnose this disease.
Assuntos
Humanos , Masculino , Feminino , Refluxo Gastroesofágico , Doença , Impedância Elétrica , Monitoramento Ambiental , Azia , Métodos , Pacientes , Endoscopia , Padrões de ReferênciaRESUMO
Resumen Introducción: la miotomía endoscópica por vía oral (POEM) se diseñó inicialmente para el manejo de la acalasia, que es un trastorno crónico y progresivo de la motilidad esofágica con hipertensión del esfínter esofágico inferior (EEI), para la cual el manejo estándar, hasta ahora, ha sido la cirugía de Heller; sin embargo, esta nueva técnica ofrece resultados muy comparables y prometedores. Materiales y métodos: se realizó una revisión retrospectiva de las historias clínicas de los pacientes con acalasia operados por POEM en una institución de Colombia por un solo cirujano endoscopista. Resultados: se encontraron 4 pacientes con acalasia, todas con Eckardt ≥10 y presión EEI ≥30 mm Hg; el tiempo quirúrgico osciló entre 81-120 minutos; en el seguimiento, la reducción en la presión del EEI fue mayor al 50% prácticamente en todos los pacientes, encontrando valores cercanos a la normalidad y con resultados de Eckardt que demuestran éxito en la terapia POEM a los 2 meses de evaluación. Las complicaciones fueron resueltas en el intraoperatorio, con mortalidad de 0%. Conclusiones: El manejo de la acalasia mediante POEM ha demostrado ser una técnica eficaz y segura. Nuestros primeros hallazgos concuerdan con los resultados descritos en la literatura. Este es el primer paso para la implementación de este novedoso abordaje en el manejo de la acalasia en la población colombiana.
Abstract Introduction: Peroral endoscopic myotomies (POEMs) were initially designed to manage achalasia, a chronic and progressive esophageal motility disorder with lower esophageal sphincter hypertension (LES). Until recently, standard treatment had been Heller's surgery, but this new technique offers very promising pressure. Materials and methods: This is a retrospective review of the clinical histories of patients with achalasia who underwent POEM performed by one endoscopic surgeon at a Colombian institution. Results: Four patients with achalasia were found. All had Eckardt scores of ten or more and lower esophageal sphincter (LES) pressure of 30mm Hg or more. Surgical times ranged between 81 and 120 minutes. Follow-up examinations found that LES pressure had decreased by more than 50% in practically all patients. Eckardt scores were close to normal. This demonstrates success of POEM therapy after two months of evaluation. Complications were resolved intraoperatively without mortality. Conclusions: Management of achalasia by POEM has proven to be a safe and effective technique. Our first findings agree with the results described in the literature. This is the first step in the implementation of this novel approach for management of achalasia in our Colombian population.
Assuntos
Humanos , Terapêutica , Acalasia Esofágica , Miotomia , Transtornos da Motilidade EsofágicaAssuntos
Gastroparesia/cirurgia , Miotomia/métodos , Piloromiotomia/métodos , Adulto , Feminino , Humanos , México , Resultado do TratamentoRESUMO
When wind speeds are 2-10 m s-1, reflective contrasts in the ocean surface make oil slicks visible to synthetic aperture radar (SAR) under all sky conditions. Neural network analysis of satellite SAR images quantified the magnitude and distribution of surface oil in the Gulf of Mexico from persistent, natural seeps and from the Deepwater Horizon (DWH) discharge. This analysis identified 914 natural oil seep zones across the entire Gulf of Mexico in pre-2010 data. Their â¼0.1 µm slicks covered an aggregated average of 775 km2. Assuming an average volume of 77.5 m3 over an 8-24 h lifespan per oil slick, the floating oil indicates a surface flux of 2.5-9.4 × 104 m3 yr-1. Oil from natural slicks was regionally concentrated: 68%, 25%, 7%, and <1% of the total was observed in the NW, SW, NE, and SE Gulf, respectively. This reflects differences in basin history and hydrocarbon generation. SAR images from 2010 showed that the 87 day DWH discharge produced a surface-oil footprint fundamentally different from background seepage, with an average ocean area of 11,200 km2 (SD 5028) and a volume of 22,600 m3 (SD 5411). Peak magnitudes of oil were detected during equivalent, â¼14 day intervals around 23 May and 18 June, when wind speeds remained <5 m s-1. Over this interval, aggregated volume of floating oil decreased by 21%; area covered increased by 49% (p < 0.1), potentially altering its ecological impact. The most likely causes were increased applications of dispersant and surface burning operations.
RESUMO
OBJECTIVES: The prevalence of hyponutrition among hospitalized patients varies between 30 to 50%, increasing both the morbidity and mortality rates. The aim of this study is to assess the incidence of hyponutrition in diabetic and non-diabetic patients at the General Surgery Department. METHODS: Prospective, observation, and longitudinal study assessing the nutritional status by means of VGS, CONUT, and MNA. RESULTS: 384 patients: 97 surgical diabetic patients, incidence of hyponutrition assessed by VGS 28.8%, by MNA among patients older than 65 years 54.28%. Two hundred and eighty seven non-diabetic surgical patients were assessed with an incidence of hyponutrition of 12.9%, and of 52.94% by MNA. CONCLUSIONS: The incidence of hyponutrition in surgical diabetic patients is twofold higher than in non-diabetic patients. Elder diabetic and non-diabetic surgical patients show the same incidence of hyponutrition. Given the high incidence of hyponutrition in surgical patients admitted to the General Surgery Department, the nutritional status should be assessed by means of a protocolled method, at admission by VSG or MNA if they are older than 65 years, and admitted patients should be followed by using CONUT.
Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Desnutrição/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Pacientes , Estudos Prospectivos , Fatores SexuaisRESUMO
Propósito: Se presentan los 2 casos de foramen oval permeable tratados con dispositivo de Amplatzer por vía percutánea. Método: El primero del sexo femenino de 48 años y con antecedentes de enfermedad de Ebstein moderada a severa y de 3 accidentes vasculares cerebrales, siendo el último bajo efecto anticoagulante, manejada con antiarrítmicos a pesar de lo cual presentó bloqueo auriculoventricular (a-v) de primer grado, aumento del automatismo supraventricular y ventricular de diferente foco y bloqueo de rama derecha. El segundo paciente masculino de 22 años con antecedente de un evento embólico cerebral a los 21 años con secuelas de crisis convulsivas. Ambos fueron tratados por vía percutánea para implante de dispositivo de Amplatzer, el primero para foramen oval permeable (FOP) y el segundo con dispositivo para comunicación interatrial por el diámetro del foramen. Los dos pacientes se encuentran asintomáticos. Conclusiones: El cierre de FOP por vía percutánea está indicado en pacientes con antecedentes de eventos cerebrales transitorios o permanentes y se sospeche esta vía como fuente embolígena. La técnica es fácil de realizar pero se requiere de un mayor número de pacientes para concluir.
Objective: We present two cases of Patent Foramen Ovale (PFO) treated with percutaneous Amplatzer device. Method: The first case corresponds to 48 years old woman with Ebstein's disease with moderate to severe hemodynamic repercussion and three cerebrovascular accidents, the last one under coumarin treatment, she received antiarrhythmic medication and despite of it developed 1st degree AV block, supraventricular and ventricular ectopia, rigth branch block. The second case corresponds to a 22 years old man with antecedents of cerebrovascular accident at the age of 21 with sequelae of convulsive crisis. Both patients were percutaneously treated with Amplatzer devices. The first patient was treated with a foramen ovale device and second with septal occluder due to the diameter of the foramen. Both patients have remained asymptomatic during the follow-up period. Conclusions: The PFO devices are indicated for patients with a history of cerebrovascular accidents.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comunicação Interatrial/cirurgia , Próteses e Implantes , Implantação de Prótese/métodos , Anomalia de Ebstein/complicações , Seguimentos , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , Resultado do TratamentoRESUMO
Forty infants, 6 to 36 mo old, with iron-deficiency anemia (hemoglobin < 11 g/dL) were matched and assigned to two groups. One group received FeS0(4) and the other received ferrous bis-glycinate chelate at a dose of 5 mg of Fe daily per kilogram of body weight for 28 d. Both groups had significant hemoglobin increases (P < 0.001), but only the group treated with ferrous bis-glycinate chelate had significant increases (P < 0.005) in plasma ferritin. Apparent iron bioavailabilities were calculated at 26.7% for FeS0(4) and 90.9% for ferrous bis-glycinate chelate. Regression analysis indicated that absorption of both sources of iron were similarly regulated by the body according to changes in hemoglobin. We concluded that ferrous bis-glycinate chelate is the iron of choice for the treatment of infants with iron-deficiency anemia because of its high bioavailability and good regulation.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Ferrosos/uso terapêutico , Glicina/análogos & derivados , Glicina/uso terapêutico , Quelantes de Ferro/uso terapêutico , Disponibilidade Biológica , Pré-Escolar , Método Duplo-Cego , Feminino , Ferritinas/sangue , Compostos Ferrosos/farmacocinética , Glicina/farmacocinética , Hemoglobinas/metabolismo , Humanos , Lactente , Absorção Intestinal , Ferro/sangue , Ferro/farmacocinética , Quelantes de Ferro/farmacocinética , Masculino , Análise de Regressão , Resultado do TratamentoRESUMO
The chemical properties of ferrous bis-glycine chelate allow for its use as a fortificant in fluid, high fat vehicles. This chemical form may also protect iron from the inhibitory or enhancing effects of the diet on iron absorption. Alternatively, iron bis-glycine chelate may be absorbed by a mechanism independent of an individual's iron stores. To test these hypotheses, the bioavailability of iron bis-glycine chelate added to water and milk was studied using a double-isotopic method in two groups of 14 women. Iron absorption from aqueous solutions of 0.27 mmol/L (15 mg/L) of elemental iron as either iron bis-glycine or ferrous ascorbate was not significantly different (34.6 and 29.9%, respectively). There were significant correlations between (log) iron absorption of iron bis-glycine with (log) serum ferritin (r = -0.60, P < 0.03) and with (log) iron absorption from ferrous ascorbate (r = 0.71, P < 0.006), suggesting that iron bis-glycine chelate bioavailability is indeed affected by iron stores. Iron absorption of iron bis-glycine given in milk was significantly lower (P < 0.002) than when given in water, with values of 11.1 and 46.3%, respectively (standardized to 40% absorption of the reference dose). With the addition of 0.57 mmol/L ascorbic acid (100 mg/L), iron absorption of iron bis-glycine given in milk increased significantly from 11.1 to 15.4% (P < 0.05). These findings show that milk and ascorbic acid affect iron bis-glycine chelate bioavailability and also demonstrate that iron stores may influence its bioavailability as well. The good bioavailability of iron bis-glycine makes this compound a suitable alternative to be considered in iron fortification programs.
Assuntos
Ácido Ascórbico/farmacologia , Compostos Ferrosos/farmacocinética , Quelantes de Ferro/farmacocinética , Leite/normas , Água/farmacologia , Adulto , Animais , Disponibilidade Biológica , Relação Dose-Resposta a Droga , Feminino , Ferritinas/sangue , Compostos Ferrosos/análise , Compostos Ferrosos/farmacologia , Alimentos Formulados , Humanos , Quelantes de Ferro/análise , Pessoa de Meia-Idade , Leite/química , Água/análiseRESUMO
A 32-mo-long, double-blind field study involving one highland control community receiving only vitamin A-fortified sugar and three vitamin A- and FeNaEDTA-sugar-fortified communities, two in the lowlands and one in the highlands of Guatemala, was undertaken to test the effectiveness of this approach in controlling iron deficiency. The communities' population ranged between 1200 and 17000. Sugar fortified with 1 g FeNaEDTA and 15 mg retinol as retinyl palmitate/kg was stable, did not segregate, and was well accepted by the communities. The impact of fortification on iron nutrition was estimated at 8, 20, and 32 mo of intervention. All pregnant women and subjects with severe anemia received supplements or treatment and were excluded from the analysis. Iron stores in the fortified communities increased significantly except for women 18-48 y of age in one lowland community and > 49 y in the highland community. Iron stores in the control community remained unchanged except for a rise among adult males.