A Randomized Double-Blind Placebo-Controlled Trial of Lactobacillus reuteri for Chronic Functional Abdominal Pain in Children

Background: Functional abdominal pain (FAP) is one of the most common diseases, and large percentages of children suffer from it. Objectives: The purpose of the study was to evaluate the effect of Lactobacillus reuteri in treatment of children with functional abdominal pain. Patients and Methods: This study was a randomized double-blind placebo-controlled trial. Children aged 4 to 16 years with chronic functional abdominal pain (based on Rome III criteria) were enrolled in the study. They were randomly divided into two groups, one receiving probiotic and the other placebo. Results: Forty children received probiotic and forty others placebo. There were no significant differences in age, weight, sex, location of pain, associated symptoms, frequency and intensity of pain between the groups. The severity and frequency of abdominal pain in the first month compared to baseline was significantly less and at the end of the second month, there was no significant difference between both groups compared to the end of the first month. Conclusions: This study showed that the severity of pain was significantly reduced in both groups. There was no significant difference in pain scores between them. The effect of probiotic and placebo can probably be attributed to psychological effect of the drugs.

Validación del ECOFAST en trauma abdominal. Hospital Vicente Corral. Cuenca 2007

Con un diseño descriptivo y una muestra propositiva se incluyeron, desde el 1 de abril de 2006 hasta el 30 de marzo de 2007, cincuenta y cinco pacientes con diagnóstico de trauma abdominal que acudieron a la emergencia del Hospital Vicente Corral a quienes se realizó ECOFAST. De estos cuarenta y tres entraron al quirófano para laparotomía; y doce permanecieron en observación con evaluación favorable y fueron dados de alta. El análisis, considerando como prueba de oro la presencia de líquido libre en cavidad tras laparotomía, se basó en la sensibilidad, especificidad y razón de verosimilitud positiva y negativa. La sensibilidad fue del 81.82 por ciento (IC95 por ciento: 61.14 a 96.49 por ciento), la especificidad del 90 por ciento (IC 95 por ciento: 66.41 a 100 por ciento), la razón de verosimilitud positiva 8.18 (IC 95 por ciento: 2.40 a - 11.6 por ciento) y la razón de verosimilitud negativa del 4.95 (IC95 por ciento: 2.28 a 21.63). El trauma contuso predominó en esta revisión en un 58.1 por ciento y la mayoría de veces causado por accidentes automovilísticos. En el análisis de los resultados encontramos un promedio de edad de 33 más menos 16.8 años. El ECOFAST es un método diagnóstico confiable en la predicción de lesiones intraabdominales en pacientes con trauma abdominal que requieren laparotomía

Threshold values of sagittal abdominal diameter for the detection of cardio-metabolic risk factors in Northeastern Mexico: a cross-sectional study

Background: The use of sagittal abdominal diameter (SAD) has been proposed for screening cardio-metabolic risk factors; however, its accuracy can be influenced by the choice of thresholds values. Aim: To determine the SAD threshold values for cardio-metabolic risk factors in Mexican adults; to assess whether parallel and serial SAD testing can improve waist circumference (WC) sensitivity and specificity; and to analyze the effect of considering SAD along with WC and body mass index (BMI) in detecting cardio-metabolic risk. Methods: This cross-sectional study was conducted during 2012-2014 in Northeast Mexico (n = 269). Data on anthropometric, clinical, and biochemical measurements were collected. Sex-adjusted receiver-operating characteristic curves (ROC) were obtained using hypertension, dysglycemia, dyslipidemia and insulin resistance as individual outcomes and metabolic syndrome as a composite outcome. Age-adjusted odds ratios and 95% confidence intervals (CI) were estimated using logistic regression. Results: The threshold value for SAD with acceptable combination of sensitivity and specificity was 24.6 cm in men and 22.5 cm in women. Parallel SAD testing improved WC sensitivity and serial testing improved WC specificity. The co-occurrence of high WC/high SAD increased the risk for insulin resistance by 2.4-fold (95% CI: 1.1-5.3), high BMI/high SAD by 4.3-fold (95% CI: 1.7-11.9) and SAD alone by 2.2-fold (95% CI: 1.2.-4.2). Conclusions: The use of SAD together with traditional obesity indices such as WC and BMI has advantages over using either of these indices alone. SAD may be a powerful screening tool for interventions for high-risk individuals.

Ejercicios adecuados de resistencia abdominal: una herramienta para la prevención contra lumbalgias

El propósito de este artículo fue el de analizar la técnica tradicional de los ejercicios abdominales, con el fin de dar recomendaciones alternativas que garanticen una buena ejecución sin riesgos. Además, presenta algunas recomendaciones que ayudarán a prescribir ejercicio abdominal para la salud.

Aproximación a la exploración ecográfica abdominal en primates de la especie Saguinus leucopus

Bogotá (Colombia): Universidad de La Salle. Facultad de Ciencias Agropecuarias. Programa de Medicina Veterinaria

Trastornos gastrointestinales funcionales en menores de dos años: prevalencia y factores asociados en una IPS Bogotá 2015 - 2016

Antecedentes: Los trastornos gastrointestinales funcionales de la infancia (TGFI) son manifestaciones gastrointestinales crónicas en cualquier parte del tubo digestivo sin daño estructural o bioquímico los cuales se pueden clasificar según los criterios de ROMA III. Se desconoce su prevalencia en niños latinoamericanos menores de 4 años. Objetivos: Estimar la prevalencia de los TGFI y cada una de sus entidades en menores de 2 años y explorar sus factores asociados. Metodología: Estudio corte trasversal con muestra aleatoria (n=323) tomada de la población de una institución de salud en la ciudad de Bogotá, realizando mediante encuesta diligenciada por los padres. El análisis se realizó por medio del software SPSS© utilizando estadística descriptiva y análisis bivariado, como medida de asociación se calculó las Razones de Disparidad (RD) con IC95%. Resultados: Se encontró una prevalencia de TGFI de 22.1%, diarrea funcional 14.6%, disquecia 12%, regurgitación 9.2%, estreñimiento 3.3%, vómito cíclico 2%, cólico infantil 1.6% y rumiación 0%. La administración de tetero durante la estancia hospitalaria neonatal se asocia con vómito cíclico RD= 6 IC 95% (1.076 – 33.447) p=0.021. La administración de formula infantil durante los primeros 6 meses de vida se asocia con diarrea funcional RD= 0.348 IC 95% (0.149 – 0.813) p=0.012 Conclusiónes: Los TGFI son una causa frecuente de molestias en los menores de 2 años de edad. Sugerimos realizar la validación del cuestionario “questionnaire on infant/toddler gastrointestinal symptoms rome version III” con el fin de mejorar la validez y precisión de los hallazgos en estudios futuros.

Desenlaces en pacientes embarazadas con patología quirúrgica abdominal 2011-2014

Estudio transversal realizado entre 2011 y 2014 en la Clínica de la Mujer con el fin de describir el comportamiento de la salud el binomio madre hijo en gestantes que requirieron manejo quirúrgico de patologías quirúrgicas abdominales no ginecobstétricas.

FAST-E en Pacientes con Trauma Abdominal Cerrado Estable, en un Departamento de Urgencias en Colombia

El impacto que ha generado el trauma en Colombia a lo largo de la historia, nos ha obligado a mejorar y adaptar diferentes tipos de sistemas de atención en trauma, basados en los lineamientos internacionales, los cuales buscan evitar el significativo aumento en las tasas de mortalidad y discapacidad que se obtienen de este, especialmente en los servicios de Emergencias en los cuales se reciben el 100% de estos pacientes con traumatismo múltiple o politraumatismo. Dentro de este grupo de pacientes hay un subgrupo que son las pacientes con trauma de abdomen que cursan con estabilidad hemodinámica y además son clasificados de bajo riesgo, ya sea por índices de trauma o por otros métodos como la medición sérica de lactato, los cuales tienen un papel poco despreciable al momento de ver mortalidad y discapacidad por trauma, ya sea penetrante o cerrado; en este trabajo específicamente nos centramos en las personas que consultan al servicio de Emergencias con trauma cerrado de abdomen los cuales son considerados de bajo riesgo, siendo este subgrupo de pacientes uno de los más difíciles de abordar y enfocar al momento de la valoración inicial, ya que se debe tener la seguridad de que no hay lesiones que comprometen la vida y por consiguiente estos pacientes puedan ser dados de alta.

CO2-EVAR: An innovative approach to Automated Carbon Dioxide Angiography during Endovascular Abdominal Aortic Aneurysm repair

Objectives CO2-EVAR was proposed for treatment of AAA especially in patients with CKD. Issues regarding standardization, such as visualization of lowest renal artery (LoRA) and quality image in angiographies performed from pigtail or introducer-sheath, are still unsolved. Aim of the study was to analyze different steps of CO2-EVAR to create an operative protocol to standardize the procedure. Methods Patients undergoing CO2-EVAR were prospectively enrolled in 5 European centers (2018-2021). CO2-EVAR was performed using an automated injector. LoRA visualization and image quality (1-4) were analyzed and compared at different procedure steps: preoperative CO2-angiography from Pigtail/Introducer-sheath (1st Step), angiographies from Pigtail at 0%,50%,100% main body (MB) deployment (2nd Step), contralateral hypogastric artery (CHA) visualization with CO2 injection from femoral Introducer-sheath (3rd Step) and completion angiogram from Pigtail/Introducer-sheath (4th Step). Intra-/postoperative adverse events were evaluated. Results Sixty-five patients undergoing CO2-EVAR were enrolled, 55/65(84.5%) male, median age 75(11.5) years. Median ICM was 20(54)cc; 19/65(29.2%) procedures were performed with 0-iodine. 1st Step: median image quality was significantly higher with CO2 injected from femoral introducer [Pigtail2(3)vs.3(3)Introducer,p=.008]. 2nd Step: LoRA was more frequently detected at 50% (93%vs.73.2%, p=.002) and 100% (94.1%vs.78.4%, p=.01) of MB deployment compared with first angiography from Pigtail; image quality was significantly higher at 50% [3(3)vs.2(3),p=<.001] and 100% [4(3) vs.2(3),p=.001] of MB deployment. CHA was detected in 93% cases (3rd Step). Mean image quality was significantly higher when final angiogram (4th Step) was performed from introducer (Pigtail2.6±1.1vs.3.1±0.9Introducer,p=<.001). Rates of intra-/postoperative adverse events (pain,vomit,diarrhea) were 7.7% and 12.5%. Conclusions Preimplant CO2-angiography should be performed from Introducer-sheath. MB steric bulk during its deployment should be used to improve image quality and LoRA visualization with CO2. CHA can be satisfactorily visualized with CO2. Completion CO2-angiogram should be performed from femoral Introducer-sheath. This operative protocol allows to perform CO2-EVAR with minimal ICM and low rate of mild complications.

Development of a hydrogel construct to prevent endoleaks occurrence following endovascular abdominal aortic aneurysm repair

Abdominal aortic aneurysm is the pathological dilation of the abdominal tract of the aorta and, if left untreated, could undergo rupture with a mortality rate of up to 90%. EVAR is the most common method for AAA treatment consisting in the internal coverage of the aorta with a metallic stent to isolate the aneurysmatic segment from the systemic circulation. Although EVAR technical success rate is high, reinterventions are common. Among the causes of reinterventions typeII endoleaks are the most frequent and consist in retrograde blood flow into the aneurysmal sac from collateral aortic branches. Continued perfusion of the aneurysm sac may lead to aneurysm rupture, therefore AAA sac embolization is performed using metallic coils. However, the presence of artifacts caused by the presence of metallic coils is a limitation because they are radiopaque and can hamper the endoleak during imaging follow-up. This study is aimed at developing a biocompatible hydrogel that could be injected into the aneurysmal sac and may allow a selective intraprocedural sac embolization to reduce post procedural typeII endoleak and eventual AAA rupture. P(BT75BSI25) was synthesized by polycondensation and its biocompatibility tested to assess whether the polymers had no toxic effects. HUVEC cell line was used to mimic the environment in which the polymer would be in contact with, PBS was used as a positive control and MTT assay was performed to evaluate cellular viability after being in contact with the hydrogel. MTT assay showed no significant difference between PBS and P(BT75BSI25), thus the polymer is biocompatible, as confirmed by the analysis of apoptosis by flow cytometry. An aromatic copolymer was obtained via polycondensation and was found to be biocompatible in contact with endothelial cells. This suggests that the hydrogel could be potentially used in the clinical setting for the treatment of type II endoleak after EVAR.

Dor abdominal: causas comuns

Vídeo compõe o módulo Intercorrências Agudas no Domicílio I do Curso de Atenção Domiciliar, da UNA-SUS/UFMA. Apresenta a divisão do abdômen e as doenças associadas a cada parte desse órgão, a fim de propiciar uma avaliação adequada.

Avaliação e manejo de casos de dor abdominal

Material da Unidade 8 que compõe o Módulo 14 “Intercorrências agudas no domicílio I” do Programa Multicêntrico de Qualificação em Atenção Domiciliar a Distância, produzido pela UNA-SUS/UFMA. Aborda o conceito de dor abdominal, como classificá-la, como proceder com a anamnese, as formas de manejo e de referenciamento.

Atenção domiciliar: caso clínico [dor abdominal]

Vídeo produzido com o GoAnimate! e que apresenta o paciente Seu João solicitando uma visita da equipe de atenção domiciliar com queixas de dores abdominais. O vídeo instiga a reflexão, a fim de solucionar o caso.

Hemorrhagic Shock Secondary To Button Battery Ingestion.

Button battery ingestion is a frequent pediatric complaint. The serious complications resulting from accidental ingestion have increased significantly over the last two decades due to easy access to gadgets and electronic toys. Over recent years, the increasing use of lithium batteries of diameter 20 mm has brought new challenges, because these are more detrimental to the mucosa, compared with other types, with high morbidity and mortality. The clinical complaints, which are often nonspecific, may lead to delayed diagnosis, thereby increasing the risk of severe complications. A five-year-old boy who had been complaining of abdominal pain for ten days, was brought to the emergency service with a clinical condition of hematemesis that started two hours earlier. On admission, he presented pallor, tachycardia and hypotension. A plain abdominal x-ray produced an image suggestive of a button battery. Digestive endoscopy showed a deep ulcerated lesion in the esophagus without active bleeding. After this procedure, the patient presented profuse hematemesis and severe hypotension, followed by cardiorespiratory arrest, which was reversed. He then underwent emergency exploratory laparotomy and presented a new episode of cardiorespiratory arrest, which he did not survive. The battery was removed through rectal exploration. This case describes a fatal evolution of button battery ingestion with late diagnosis and severe associated injury of the digestive mucosa. A high level of clinical suspicion is essential for preventing this evolution. Preventive strategies are required, as well as health education, with warnings to parents, caregivers and healthcare professionals.

Migraine Equivalents In Childhood.

Migraine equivalents are a group of periodic and paroxysmal neurologic diseases. Because headache is not a prominent symptom, the diagnosis might be challenging. The objective of the study was to evaluate the frequency and outcome of migraine equivalents. This was a retrospective study. We included benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of infancy, abdominal migraine, cyclic vomiting, aura without migraine, and confusional migraine. We evaluated the frequency of events, treatment, and outcome. Out of 674 children with headache, 38 (5.6%) presented with migraine equivalents. Twenty-one were boys and the mean age was 6.1 years. Fifteen had abdominal migraine, 12 benign paroxysmal vertigo, 5 confusional migraine, 3 aura without migraine, 2 paroxysmal torticollis, and 1 cyclic vomiting. Prophylactic treatment was introduced in 23 patients; 4 lost follow-up and 19 had significant improvement. We conclude that the correct diagnosis of migraine equivalents enables an effective treatment with an excellent outcome.