788 VARIABLE GEOGRAPHICAL DIFFERENCES OF AMBULATORY ESOPHAGEAL REFLUX MONITORING IN MEXICO

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Genaro Vazquez-Elizondo ◽  
José María Remes-Troche ◽  
Enrique Coss-Adame ◽  
Edgardo Suárez-Morán ◽  
Miguel Ángel Valdovinos-Díaz ◽  
...  
Keyword(s):  
Data Base ◽  
Positive Symptom ◽  
Central Mexico ◽  
Limited Information ◽  
Esophageal Reflux ◽  
Erosive Disease ◽  
Functional Heartburn ◽  
Symptom Association Probability ◽  
Common Diagnosis ◽  
Diagnostic Outcome

Abstract   Ambulatory esophageal reflux monitoring (AEpH) is useful in evaluating persistent or refractory esophageal symptoms despite adequate pharmacologic and/or surgical therapy. There is limited information whether there are geographical or regional differences in the diagnostic outcome of this test. Aim Characterize the diagnostic outcome of AEpH in a diverse population of Mexico. Analyze whether there is regional geographical diagnostic variability. Methods Data was collected from four major referral centers representing diverse geographical areas of Mexico: Mexico City-Central (two centers, years 2016-2020), Veracruz-South (years 2015-2020) and Monterrey-North (years 2013-2020). Consecutive patients undergoing AEpH with persistent GERD symptoms despite PPI therapy and negative upper endoscopy (no erosive disease >C or D LA classification) were entered into a data base and analyzed. Patients were classified as: NERD (acid exposure time (AET > 6.0%); hypersensitive esophagus (normal AET and positive symptom index (SI) or positive symptom association probability [SAP]); functional heartburn (NL AET, neg SI/SAP). Statistics: ANOVA, Chi-square and descriptive methods were used to compare variables among groups. Results 969 cases met inclusion criteria: 311 (32.1%) Central, 430 (44.3%) South, and 228 (23.5%) North. The results are summarized in the table. There were more women 618(63.8%) than men 351(36.2%); p < 0.001 with a mean age 47.7 ± 14.3. Patients were older in Central-Mexico 49.3 ± 13.6 years vs South 47.5 ± 15 and North 46.1 ± 13.6; p = 0.033. Functional heartburn was the most common diagnosis overall and more prevalent in Central-Mexico 171(55%) vs North 97(42.5%) and South 160(37.2%); p < 0.001. NERD was more predominant in the South 171(39.8%) vs North 72(31.6%) and Central-Mexico 98(31.5%); p = 0.029. Hypersensitive esophagus was more frequent in the North 59(25.9%) vs South 99(23%), and Central 42(13.5%); p < 0.001. Conclusion This is the first large data base study to evaluate the outcome of ambulatory esophageal reflux pH testing in Mexico. Our findings indicate a geographical variability of GERD phenotypes and suggest that further investigations are warranted to determine the causes of this distribution.

789 HIGH RESOLUTION ESOPHAGEAL MOTILITY: VARIABLE GEOGRAPHIC DISTRIBUTION IN A LARGE MEXICAN COHORT

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Genaro Vazquez-Elizondo ◽  
José María Remes-Troche ◽  
Enrique Coss-Adame ◽  
Edgardo Suárez-Morán ◽  
Miguel Ángel Valdovinos-Díaz ◽  
...  
Keyword(s):  
High Resolution ◽  
Data Base ◽  
Regional Differences ◽  
Outlet Obstruction ◽  
Central Mexico ◽  
Diverse Population ◽  
Chi Square ◽  
The North ◽  
Available Information ◽  
Diagnostic Outcome

Abstract   High resolution esophageal manometry (HREM) has been in use for about a decade. However, there is no available information regarding geographical or regional differences in diagnostic outcome. Aim Characterize the indications, demographics and diagnostic outcome of HREM in a diverse population of Mexico. Methods Data was collected from four major referral centers representing diverse geographical areas of Mexico: central—Mexico City (two centers, years 2016-2020), south (Veracruz, years 2015-2020) and north (Monterrey, years 2013—2020). All consecutive cases referred for HREM were entered into a data base and analyzed using Chicago 3 classification. Data was evaluated using chi-square to compare frequencies among groups. Results 2,932 patients included: Central n = 877(29.9), North n = 1003(34.2), South n = 1052(35.9). Mean age 47.9(11-93), women 1,795(61.2), men 1,137(38.8). Nationwide, the most common indications for testing were: GERD n = 1677(57.2), followed by dysphagia 587(20), atypical GERD 244(8.3), post-operative GERD 230(7.9), chest pain 114(3.9), and post-operative dysphagia 78(2.8). HREM was normal in 1,468(49.9) patients. Table shows the diagnostic distribution among centers: Central-Mexico had more abnormal cases 531(60.5) (p < 0.0.001) vs 407(40.6) North and 532(50.6) South. Achalasia was more commonly diagnosed in the South n = 104(19.5) whereas outlet obstruction 39(967) p < 0.001 and spastic disorders were more common in the North 47(11.8) p = 0.002. Weak peristaltic disorders were more common in Central-Mexico 369(78.8) p < 0.001. Conclusion This study represents the first large comparative multicenter HREM data base project in Mexico. In this cohort, most patients receiving HREM are women and those whose indication was GERD. These findings indicate variable regional geographical distribution of HERM diagnosis. Our study suggests that further investigation into the causes and epidemiological distribution of motility disorders is warranted.

scholarly journals Gastro-Esophageal Reflux in the Newborn: Pathologic Event or Does Spit Happen?

2021 ◽  
Vol 05 (03) ◽  
pp. 1-1
Author(s):  
Gretchen Stepanovich ◽  
◽  
Steven M. Donn ◽  
Keyword(s):  
Neonatal Intensive Care ◽  
Evidence Base ◽  
Neonatal Intensive Care Units ◽  
Pharmacologic Therapy ◽  
Esophageal Reflux ◽  
Off Label ◽  
Vulnerable Patients ◽  
Common Diagnosis ◽  
Pharmacologic Agents ◽  
Dramatic Growth

Infants admitted to Neonatal Intensive Care Units (NICUs) are among the most vulnerable patients in medicine and are at risk for a variety of morbidities, many of which require pharmacologic therapy. Gastroesophageal Reflux Disease (GERD) is a common diagnosis in the NICU patient population and may or may not represent a truly pathologic process. Regardless, pharmacologic therapy is provided to many infants, who are already exposed to an inordinate number of pharmacologic agents, of which most are off label and have an inadequate evidence base to establish either efficacy or safety. Furthermore, as infancy represents a time of dramatic growth and development, many conditions resolve over time, making treatment unnecessary and potentially dangerous. Infants with GERD, especially those born prematurely, exemplify the complexity of attempting pharmacologic therapy with unproven consistent benefit versus “watching and waiting.” The following will present physiology of GERD, gastrointestinal tract anatomy and development as well as options for pharmacologic and non-pharmacologic therapies.

scholarly journals Prevalence and lameness-associated risk factors in Alberta feedlot cattle

2019 ◽  
Vol 3 (2) ◽  
pp. 595-606 ◽  
Author(s):  
Jessica Davis-Unger ◽  
Karen S G Schwartzkopf-Genswein ◽  
Ed A Pajor ◽  
Steve Hendrick ◽  
Sonia Marti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Feedlot Cattle ◽  
Foot Rot ◽  
Limited Information ◽  
Data Set ◽  
Joint Infections ◽  
Related Risk ◽  
Common Diagnosis ◽  
And Gender ◽  
Associated Risk Factors

AbstractLameness in cattle is a health and welfare concern; however, limited information is available on risk factors and the relationship between lameness and common diseases like bovine respiratory disease (BRD). Therefore, the objectives of this study were to: 1) identify prevalence of lameness in feedlot cattle and related risk factors of cattle diagnosed as lame; and 2) determine associations between BRD occurrence and lameness. Feedlot cattle health records were available from 28 feedlots for 10 yr. The data set consisted of 663,838 cattle records, with 13.9% (92,156) diagnosed with a disease, including 32.3%, 46.0%, and 22.0% with lameness, BRD, and other diagnoses, respectively. Lameness was classified into four categories: foot rot (FR), joint infections (JI), lame with no visible swelling (LNVS), and injuries (INJ), with a prevalence of 74.5%, 16.1%, 6.1%, and 3.1%, respectively. Lameness was compared across cattle types (arrival date and weight) as well as age classification (calf vs. yearling), gender (steer vs. heifer), and season of placement in the feedlot (spring, summer, fall, and winter). Within the disease-diagnosed population, lameness represented 28.5% of treated fall-placed calves, 38.5% of winter-placed calves, and 40.8% of treated yearlings. Foot rot was the most common diagnosis with 74.5% of all lameness diagnoses, with winter- and fall-placed calves more likely to be diagnosed with FR compared to yearlings (OR: 1.19, 95% CI: 1.10–1.30 and OR: 1.46, 95% CI: 1.38–1.55, respectively). Joint infections were the second most common diagnosis (16.1%). Compared to yearlings, fall-placed calves had a higher odds (OR: 3.64, 95% CI: 3.12–4.24) for JI. Injuries and LNVS were the least common but again fall-placed calves had higher odds of this diagnosis compared to yearlings (OR: 2.26, 95% CI: 1.70–2.99 and OR: 9.10, 95% CI: 6.26–13.2, respectively). Gender was significantly different for JI as steers were less likely affected compared to heifers (OR: 0.687, 95% CI: 0.545–0.867), and more likely affected by LNVS (OR: 2.46, 95% CI: 1.57–3.84). Of all lameness-associated deaths, JI accounted for almost 50%. Finally, cattle diagnosed with BRD were subsequently more likely to be diagnosed with INJ, JI, or LNVS (P < 0.001 for all comparisons). In conclusion, animal type and gender were associated with type of lameness diagnoses, allowing feedlots to allocate resources to groups at highest risk and focus on early intervention strategies.

Psychosis in Patients with Acquired Brain Injury (ABI), Requiring Multidisciplinary Inpatient Rehabilitation

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
R. Faruqui ◽  
A. Tajer ◽  
B. Moffat ◽  
S. Haider ◽  
K. Haider ◽  
...  
Keyword(s):  
Mood Disorder ◽  
Psychotic Disorders ◽  
Suicide Attempts ◽  
Inpatient Rehabilitation ◽  
Limited Information ◽  
Psychotic Illness ◽  
Bipolar Mood Disorder ◽  
Common Diagnosis ◽  
Significant Difference ◽  
History Of

Background:Patients with ABI present with a relatively higher risk of developing psychotic illness. A co-morbid psychotic illness may pose multiple challenges in rehabilitation of these patients. The medical literature provides limited information on the nature, presentation, diagnosis, course, and prognosis of psychotic disorders after ABI.Methods:Clinically generated data was used to study the prevalence and nature of co-morbid psychotic illness and cause of ABI amongst inpatients requiring multidisciplinary neurobehavioral rehabilitation. The data were collected in an anonymized fashion and analyzed using SPSS version 16.Results:We examined data from 64 patients (51 Male, 13 Female). The age range was 21-61 years (Mean 39, S.D. 10.6). 40% patients had a history of mental illness or self harm prior to ABI. 16% had sustained their ABI as a result of suicide attempts. 12% had history of schizophrenia or bipolar mood disorder prior to ABI.A third (33%) had a Post-ABI diagnosis of a psychotic illness. The most common diagnosis was organic psychosis (21%) followed by schizophrenia (9%) and bipolar mood disorder (3%). The factors that influenced diagnostic differentiation in organic or non-organic psychotic illness included consideration of past psychiatric history, family history, psychopathology, and course of the disorder. The overall patient group showed a significant difference in post admission and latest HONOS-Secure (P< 0.01) and HONOS ABI (P< 0.01) ratings, showing improvement in outcomes during rehabilitation programme. This difference persisted when sub-groups of psychotic and non-psychotic patients were analysed separately.

Symptom association probability does not reliably distinguish functional heartburn from reflux hypersensitivity

2018 ◽  
Vol 47 (7) ◽  
pp. 958-965 ◽  
Author(s):  
Y. Choksi ◽  
J. C. Slaughter ◽  
R. Sharda ◽  
T. Higginbotham ◽  
P. Lal ◽  
...  
Keyword(s):  
Functional Heartburn ◽  
Symptom Association Probability

scholarly journals Vegetal and Animal Food Proteins Have a Different Impact in the First Postprandial Hour of Impedance-pH Analysis in Patients with Heartburn

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Irene Martinucci ◽  
Giada Guidi ◽  
Edoardo V. Savarino ◽  
Marzio Frazzoni ◽  
Salvatore Tolone ◽  
...  
Keyword(s):  
Ph Monitoring ◽  
Acid Reflux ◽  
Animal Protein ◽  
The Other ◽  
Positive Symptom ◽  
Protein Meal ◽  
Female Ratio ◽  
Functional Heartburn ◽  
Vegetable Proteins ◽  
Total Reflux

Background and Aims. By means of 24 h impedance-pH monitoring, we aimed to evaluate the effect of two different meals with a bromatological balanced composition: one with a prevailing component of animal proteins and the other with vegetable proteins.Patients and Methods. We enrolled 165 patients with heartburn and negative endoscopy, who underwent impedance-pH monitoring off therapy. Patients were allocated to receive a Mediterranean diet with a total caloric intake of about 1694 kcal, divided into two meals: one with a prevailing component of animal proteins and the other with vegetable proteins. We evaluated the total reflux number, acid exposure time (AET), and symptom-reflux association with impedance-pH analysis. Moreover, during the first postprandial hour (at lunch and dinner), we evaluated the total reflux number, number of acid and weakly acidic refluxes, AET, and presence of symptoms.Results. The male/female ratio was 80/85. Mean age was 51.9 ± 12.1 years. Impedance-pH analysis showed that 55/165 patients had pathological AET or a number of refluxes (nonerosive reflux disease (NERD)), 49/165 had normal AET and a number of refluxes but positive symptom-reflux association (hypersensitive esophagus (HE)), and 61/165 had normal AET and a number of refluxes with negative symptom-reflux association (functional heartburn (FH)). The overall first postprandial hour analysis showed a higher total reflux number, acid reflux number, and AET after the animal protein meal than after the vegetable protein meal. Moreover, more symptoms were reported after the animal protein meal. Similar results have been observed in the three different subcategories of patients (NERD, HE, and FH).Conclusions. Vegetable proteins are associated with a lower number of refluxes, particularly acid refluxes, and with a reduced number of symptoms during the first postprandial hour. This is a pilot study and future investigations are warranted to confirm these results.

Ultrastructure of the effect of T-514 obtained from Karwinskia humboldtiana on assembly and integrity of yeast's peroxisomes

1991 ◽  
Vol 49 ◽  
pp. 136-137
Author(s):  
J. Sepulveda-Saavedra ◽  
I. Vander-Klei ◽  
M. Venhuis ◽  
Y. Piñeyro-Lopez
Keyword(s):  
Culture Conditions ◽  
Toxic Effects ◽  
Candida Boidinii ◽  
Central Mexico ◽  
Poisonous Plant ◽  
Biological Behaviour ◽  
Enzyme Content ◽  
Fat Deposits ◽  
Yeast Model

Karwinskia humboldtiana is a poisonous plant that grows in semi desertic areas in north and central México. It produces several substances with different toxic effects. One of them designated T-514 damages severely the lung, kidney and liver, producing in the hepatoeyte large intracellular fat deposits and necrosis. Preliminary observations demonstrated that three is a decrease in the amount of peroxisomes in the hepatocytes of experimentally intoxicated rats and monkeys. To study the effect exerted by the T-514 on peroxisomes, a yeast model was selected, thus, three species: Saccha romices cerevisiae, Ilansenula polymorpha and Candida boidinii were used, because there is information concerning their peroxisome's morphology, enzyme content, biological behaviour under different culture conditions and biogenesis.

Ultrastructural Changes in Tumor Cells During Human Peripheral Blood Monocyte-Mediated Cytotoxicity

1981 ◽  
Vol 39 ◽  
pp. 452-453
Author(s):  
K. E. Muse ◽  
D. G. Fischer ◽  
H. S. Koren
Keyword(s):  
Target Cell ◽  
Human Peripheral Blood ◽  
Mononuclear Phagocytes ◽  
Ultrastructural Changes ◽  
Target Cells ◽  
Limited Information ◽  
Blood Monocytes ◽  
Tumoricidal Activity ◽  
Activated State

Mononuclear phagocytes, a pluripotential cell line, manifest an array of basic extracellular functions. Among these physiological regulatory functions is the expression of spontaneous cytolytic potential against tumor cell targets.The limited observations on human cells, almost exclusively blood monocytes, initially reported limited or a lack of tumoricidal activity in the absence of antibody. More recently, freshly obtained monocytes have been reported to spontaneously impair the biability of tumor target cells in vitro (Harowitz et al., 1979; Montavani et al., 1979; Hammerstrom, 1979). Although the mechanism by which effector cells express cytotoxicity is poorly understood, discrete steps can be distinguished in the process of cell mediated cytotoxicity: recognition and binding of effector to target cells,a lethal-hit stage, and subsequent lysis of the target cell. Other important parameters in monocyte-mediated cytotoxicity include, activated state of the monocyte, effector cell concentrations, and target cell suseptibility. However, limited information is available with regard to the ultrastructural changes accompanying monocyte-mediated cytotoxicity.

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