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Antecedentes En una cesarea se puede emplear analgesia epidural con bupivacaina 0.125% and lidocaina 1.5% o bupivacaina 0.25% and lidocaina 1.0%. Una concentracion mayor de bupivacaina alcanza mayor analgesia con mas eventos adversos. OBJETIVO evaluar la analgesia y seguridad de bupivacaina 0.125% and lidocaina 1.5% o bupivacaina 0.25% and lidocaina 1.0%. MATERIALES Y METODOS Cohorte prospectivo estratificado segun ambas concentraciones de bupivacaina. RESULTADOS Se recupero cien gestantes a termino (cincuenta por cohorte). A los 20 y 30 minutos tras la administracion epidural hubo mas casos con mayor bloqueo motor en quienes se empleo bupivacaina 0.125% and lidocaina 1.5% (p = 0.0229 y p = 0.0006, respectivamente). No hubo diferencia significativa respecto al bloqueo sensitivo. Bupivacaina 0.25% and lidocaina 1.5% mostro una tencencia a la hipotension (p < 0.001) y a la bradicardia (p = 0.4100). De la cohorte de bupivacaina 0.125% and lidocaina 1.5%, 25 casos (50%) presentaron cuando menos un evento adverso, en contraste con 44/50 (88%) de la cohorte de bupivacaina 0.25% and lidocaina 1.0% (p < 0.001). CONCLUSION En la analgesia epidural durante cesarea, bupivacaina 0.125% and lidocaina 1.5% esta asociado con un efecto analgesico similar a bupivacaina 0.25% and lidocaina 1.0%. Sin embargo, mayores concentraciones estan significativamente relacionadas con mayor tasa de eventos adversos (especialmente hipotension). BACKGROUND In a cesarean section, epidural analgesia with 0.125% bupivacaine and 1.5% lidocaine or 0.25% bupivacaine with 1.0% lidocaine concentrations can be used. A higher concentration of bupivacaine reaches better analgesia but with a higher rate of drug-related adverse events. AIM The aim of the study was to assess analgesia and safety of 0.125% bupivacaine and 1.5% lidocaine or 0.25% bupivacaine with 1.0% lidocaine during cesarean. MATERIALS AND METHODS Prospective cohort stratified following both bupivacaine concentrations. RESULTS One hundred women with full-term pregnancies were selected (fifty per cohort). At 20 and 30 min after epidural administration, there was a higher proportion of motor blockade cases from the 0.125% bupivacaine and 1.5% lidocaine cohort (p = 0.0229 and p = 0.0006, respectively). There was no significant difference among sensitive blockage. A 0.25% bupivacaine and 1.0% lidocaine concentration showed a tendency to hypotension (p < 0.001) and bradycardia (p = 0.4100). From 0.125% bupivacaine and 1.5% lidocaine cohort, 25 cases (50%) presented at least one adverse event; in contrast with 44/50 (88%) from 0.25% bupivacaine and 1.0% lidocaine cohort (p < 0.001). CONCLUSION In epidural analgesia during cesarean, using 0.125% bupivacaine and 1.5% lidocaine presented similar analgesia than 0.25% bupivacaine and 1.0% lidocaine. However, a higher bupivacaine concentration is significantly related to more frequent drug-related adverse events (especially hypotension).

En una cesárea se puede emplear analgesia epidural con bupivacaína 0.125% and lidocaína 1.5% ó bupivacaína 0.25% and lidocaína 1.0%. Una concentración mayor de bupivacaína alcanza mayor analgesia con más eventos adversos.evaluar la analgesia y seguridad de bupivacaína 0.125% and lidocaína 1.5% ó bupivacaína 0.25% and lidocaína 1.0%.Cohorte prospectivo estratificado según ambas concentraciones de bupivacaína.Se recuperó cien gestantes a término (cincuenta por cohorte). A los 20 y 30 minutos tras la administración epidural hubo más casos con mayor bloqueo motor en quienes se empleó bupivacaína 0.125% and lidocaína 1.5% (p = 0.0229 y p = 0.0006, respectivamente). No hubo diferencia significativa respecto al bloqueo sensitivo. Bupivacaína 0.25% and lidocaína 1.5% mostró una tencencia a la hipotensión (p0.001) y a la bradicardia (p = 0.4100). De la cohorte de bupivacaína 0.125% and lidocaína 1.5%, 25 casos (50%) presentaron cuando menos un evento adverso, en contraste con 44/50 (88%) de la cohorte de bupivacaína 0.25% and lidocaína 1.0% (p0.001).En la analgesia epidural durante cesárea, bupivacaína 0.125% and lidocaína 1.5% está asociado con un efecto analgésico similar a bupivacaína 0.25% and lidocaína 1.0%. Sin embargo, mayores concentraciones están significativamente relacionadas con mayor tasa de eventos adversos (especialmente hipotensión).In a cesarean section, epidural analgesia with 0.125% bupivacaine and 1.5% lidocaine or 0.25% bupivacaine with 1.0% lidocaine concentrations can be used. A higher concentration of bupivacaine reaches better analgesia but with a higher rate of drug-related adverse events.The aim of the study was to assess analgesia and safety of 0.125% bupivacaine and 1.5% lidocaine or 0.25% bupivacaine with 1.0% lidocaine during cesarean.Prospective cohort stratified following both bupivacaine concentrations.One hundred women with full-term pregnancies were selected (fifty per cohort). At 20 and 30 min after epidural administration, there was a higher proportion of motor blockade cases from the 0.125% bupivacaine and 1.5% lidocaine cohort (p = 0.0229 and p = 0.0006, respectively). There was no significant difference among sensitive blockage. A 0.25% bupivacaine and 1.0% lidocaine concentration showed a tendency to hypotension (p0.001) and bradycardia (p = 0.4100). From 0.125% bupivacaine and 1.5% lidocaine cohort, 25 cases (50%) presented at least one adverse event; in contrast with 44/50 (88%) from 0.25% bupivacaine and 1.0% lidocaine cohort (p0.001).In epidural analgesia during cesarean, using 0.125% bupivacaine and 1.5% lidocaine presented similar analgesia than 0.25% bupivacaine and 1.0% lidocaine. However, a higher bupivacaine concentration is significantly related to more frequent drug-related adverse events (especially hypotension).

During the COVID-19 pandemic, portable chest radiography (portable CRx) and lung ultrasonography (LUS) have been widely used to follow up hospitalized patients. Yet, it is scarce the information about the relation between the signs observed by means of each method in patients with COVID-19.To assess the correlation between concurrent images acquired by LUS and portable CRx during the follow-up of hospitalized patients with COVID-19.We performed 113 LUS and 113 corresponding CRx during the follow-up of 44 patients (30 men/14 women, 30-85 years old) with COVID-19 (RT-qPCR). Images were stored in a picture communication system and were revised by two specialists of each imaging method independently. Statistical analysis was performed using Gamma correlation and t test (significance level of 0.05).The most frequent LUS sign was confluent B lines, and it was related to the most frequent portable CRx signs (ground-glass opacities and consolidations). An inverse relationship was observed between A lines (gas in the lungs) and B7 lines (suggestive of interstitial edema). Confluent B lines also showed a strong inverse correlation with A lines (more frequent confluent B lines were related to low frequent A lines), a moderate inverse correlation with B7 lines, and a mild inverse correlation with B3 lines.During the follow-up of hospitalized patients with COVID-19, LUS and portable CRx may complement each other to provide information about lung damage.durante la pandemia por COVID-19, la radiografía portátil de tórax y la ultrasonografía se han usado ampliamente para el seguimiento de pacientes hospitalizados. Sin embargo, es escasa la información sobre la relación entre los signos que se observan mediante cada método en pacientes con COVID-19.estimar la correlación entre imágenes concurrentes obtenidas por ultrasonografía de pulmón y por radiografía portátil de tórax durante el seguimiento de pacientes hospitalizados por COVID-19.se realizaron 113 estudios de ultrasonografía y los correspondientes 113 de radiografía portátil de tórax durante el seguimiento de 44 pacientes (30 hombres/14 mujeres, edad 30-85 años) con COVID-19 (RT-qPCR). Las imágenes se resguardaron en un sistema de comunicación para su evaluación independiente por dos especialistas en cada método. El análisis se hizo con correlación gamma y prueba t (significancia de 0.05).el signo por ultrasonido más frecuente fue el de líneas B-confluentes en correlación con los signos radiológicos de imagen en vidrio deslustrado y consolidación. Se observó correlación inversa entre líneas A (pulmón aireado) y líneas B7 (sugerentes de edema intersticial); las líneas B-confluentes mostraron correlación inversa y fuerte con líneas A (a mayor frecuencia de líneas B-confluentes, menor frecuencia de líneas A), correlación inversa moderada con líneas B7 y correlación inversa débil con líneas B3.en el seguimiento de pacientes hospitalizados por COVID-19, los signos por ultrasonografía pulmonar y por radiografía portátil de tórax pueden ser complementarios para identificar las características del daño pulmonar.

Introducción: un catéter venoso central está expuesto a adhesión bacteriana y colonización por parte de microorganismos de la piel en vecindad a su sitio de inserción. El hospital “Dr. Abel Gilbert Pontón” es el segundo hospital público más grande de la costa ecuatoriana. Aquí se dispone de gluconato de clorhexidina al 2% y Iodo–povidona al 10% para la asepsia y antisepsia del sitio de punción previa colocación de un catéter venoso central. Objetivo: determinar el efecto de la asepsia y antisepsia con Gluconato de clorhexidina al 2% versus Iodo–povidona al 10% en la prevención de colonización del catéter venoso central. Métodos: estudio observacional analítico, longitudinal, del tipo cohorte histórico, realizado en la unidad de cuidados intensivos del hospital “Dr. Abel Gilbert Pontón” de mayo-2013 a abril-2014. El efecto del agente antiséptico en la prevención de colonización del catéter venoso central se determinó mediante cálculo del riesgo relativo, reducción del riesgo relativo y número de pacientes que es necesario tratar. Resultados: se recuperó 786 pacientes, edad promedio 56,41 ± 16,3 años, 376 (47,8%) género femenino. En 357 (45,4%) pacientes se empleó gluconato de clorhexidina al 2%. El efecto de la antisepsia de dicho agente, en la prevención de colonización del catéter venoso central presentó un riesgo relativo de 1,012 (IC 95% 0,874 – 1,173; p=0,871), con una reducción del riesgo relativo del 1,2% y un número de pacientes que es necesario tratar de 173. Conclusión: en la práctica diaria en la unidad de cuidados intensivos del hospital “Dr. Abel Gilbert Pontón”, Gluconato del clorhexidina al 2%, en comparación con Iodo–povidona al 10%, presentó un efecto antiséptico superior en la prevención de colonización del catéter venoso central el cual no fue estadísticamente significativo. Se prefiere Gluconato de clorhexidina al 2% como agente antiséptico para tal fin, según lo recomienda la literatura actual.

Aims We aimed to evaluate the combination of telemedicine consultation and routinely serological screening for resumingactivities in the endoscopy unit. Methods A single-center, cohort study (April/15 to May/22). Patients were screened via telemedicine consult by apulmonologist for a history of acute symptoms, close contacts, or exposure to COVID-19. Serological screening within 24-hours prior to endoscopic procedures was performed and combined with clinical interpretation. The endoscopy staff wasscreened for symptoms and COVID-19 infection via PCR-swab before and after the protocol instauration for resumingactivities. Social distancing on the preparation, endoscopy, and recovering room, as well as personal protective equipment, and an aerosol box shield for intubation in those cases requiring general anesthesia. Patients were follow-up up to 4-weeksand screened for COVID-19 symptoms. Results 127 patients were included in the study period. 9/127 exhibited positive IgM antibodies against COVID-19 (7/9patients had mild clinical presentation whereas 2/9 were asymptomatic). Their endoscopic procedures were differed until anegative PCR-swab test was obtained. 118 patients were submitted to endoscopic procedures following the protocol. Themedian age was 45 years, 64.4 % were female. The mean body temperature of 37 C. 13.6 % were hospitalized patients. Ofthe 118 patients treated, 53.4 % were for therapeutic procedures while 46.6 % were diagnostic. 85.6 % of the procedures were categorized as non-urgent whereas 14.4 % as urgent. The frequencies of the endoscopic procedures were describedas: Esophagogastroduodenoscopy 45.8 %, colonoscopy 2.5 %, ERCP 22.0 %, cholangioscopy 15.3 %, and endoscopicultrasound 14.4 %. Any nosocomial COVID-19 infection within the endoscopy staff and patients was reported during theprotocol and 1-month follow-up. Conclusions A combined telemedicine consultation following by a serological screening allows a safe resuming of activitiesin the endoscopy unit at a low cost. Social distancing during preparation and recovery room, as well as personal protectiveequipment, plays a role in managing the spreading of COVID-19.

Introduction We designed a follow‐up study of frontline health workers at COVID‐19 patient care, within the same working conditions, to assess the influence of their general characteristics and pre‐existing anxiety/depression/dissociative symptoms and resilience on the development of symptoms of post‐traumatic stress disorder (PTSD), while monitoring their quality of sleep, depersonalization/derealization symptoms, acute stress, state anxiety, and burnout. Methods In a Hospital reconfigured to address the surge of patients with COVID‐19, 204 frontline health workers accepted to participate. They completed validated questionnaires to assess mental health: before, during, and after the peak of inpatient admissions. After each evaluation, a psychiatrist reviewed the questionnaires, using the accepted criteria for each instrument. Correlations were assessed using multivariable and multivariate analyses, with a significance level of .05. Results Compared to men, women reporting pre‐existing anxiety were more prone to acute stress; and younger age was related to both pre‐existent common psychological symptoms and less resilience. Overall the evaluations, sleep quality was bad on the majority of participants, with an increase during the epidemic crisis, while persistent burnout had influence on state anxiety, acute stress, and symptoms of depersonalization/derealization. PTSD symptoms were related to pre‐existent anxiety/depression and dissociative symptoms, as well as to acute stress and acute anxiety, and negatively related to resilience. Conclusions Pre‐existent anxiety/depression, dissociative symptoms, and coexisting acute anxiety and acute stress contribute to PTSD symptoms. During an infectious outbreak, psychological screening could provide valuable information to prevent or mitigate against adverse psychological reactions by frontline healthcare workers caring for patients., During an infectious outbreak, pre‐existing burnout, dissociative experiences, and anxiety contribute to the development of post‐traumatic stress disorder in frontline health workers. To protect the mental health of vulnerable personnel and decrease the probability of latent human errors, psychological screening of health‐workers could provide valuable information to design staff reorganization.

Background and study aims Probe-based confocal laser endomicroscopy (pCLE) can provide high magnification to evaluate chronic atrophic gastritis (CAG), but the current pCLE criteria are qualitative and prone to variability. We aimed to propose a quantitative CAG criterion based on pCLE to distinguish non-atrophic gastritis (NAG) from CAG. Patients and methods This observational, exploratory pilot study included patients with NAG and CAG evaluated via esophagogastroduodenoscopy, pCLE, and histology. We measured the gastric glands density, gastric gland area, and inter-glandular distance during pCLE. Results Thirty-nine patients (30/39 with CAG) were included. In total, 194 glands were measured by pCLE, and 18301 were measured by histology, with a median of five glands per NAG patient and 4.5 per CAG patient; pCLE moderately correlate with histology (rho = 0.307; P = 0.087). A gland area of 1890–9105 µm2 and an inter-glandular distance of 12 to 72 µm based on the values observed in the NAG patients were considered normal. The proposed pCLE-based CAG criteria were as follows: a) glands density 1/4 the pCLE field area (> 9105 µm2); or c) inter-glandular distance 72 µm; CAG was diagnosed by the presence of at least one criterion. The proposed criteria discriminated CAG with a ranged sensitivity of 76.9 % to 92.3 %, a negative predictive value of 66.6 % to 80.0 %, and 69.6 % to 73.9% accuracy. Conclusions The proposed pCLE criteria offer an accurate quantitative measurement of CAG with high sensitivity and excellent interobserver agreement. Larger studies are needed to validate the proposed criteria.

The aim of the study was to determine the usefulness of known biomarkers as pre-operative predictors of complicated acute appendicitis (CAA) and perforated appendicitis (PA).This was an observational, analytic, cross-sectional, and prospective study at Hospital Teodoro Maldonado Carbo (August 2016-December 2017). Evaluated biomarkers: white blood cells count, neutrophil percentage (N%), neutrophil-to-lymphocyte ratio, glucose, total bilirubin, C-reactive protein, and procalcitonin (PCT). The statistical analysis was performed by means of the area under the receiver operating characteristics (AUROC) curve estimation. Biomarkers' cutoff point was identified using Youden's index. Sensitivity, specificity, positive, and negative predictive value (NPV) (positive predictive value [PPV] and NPV) were estimated.One hundred and twenty-eight cases were included (median age 30 years, 44% female), 70 cases (54%) corresponded to CAA (PA 38/70). N% and PCT obtained an AUROC of 78% and 80% for CAA (PA 76% and 81%), respectively. A N%78.1% predicted CAA with a sensitivity, specificity, PPV, and NPV of 82%, 62%, 72%, and 72% (74.9%, PA: 94%, 53%, 46%, and 96%), respectively. PCT0.14 ng/dL predicted CAA with sensitivity, specificity, PPV, and NPV of 69%, 79%, 80%, and 68% (PA: 84%, 69%, 53%, and 91%).The N% and PCT represent useful pre-operative biomarkers for discarding PA when an acute appendicitis is suspected.Determinar la utilidad de conocidos biomarcadores como predictores de apendicitis aguda complicada (AAC) y perforada (AP).Estudio observacional, analítico, transversal, de recuperación prospectiva, realizado en el Hospital Teodoro Maldonado Carbo (agosto de 2016 a diciembre de 2017). Biomarcadores evaluados: glóbulos blancos, porcentaje de neutrófilos (%N), índice neutrófilo/linfocito, glucosa, bilirrubina total, proteína C reactiva y procalcitonina (PCT). El análisis estadístico se realizó mediante estimación del área bajo la curva ROC (Receiver Operating Characteristics). Se individualizó el valor de corte mediante el índice de Youden. Se estimaron la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN).Se incluyeron 128 casos (mediana de edad 30 años, 44% mujeres), de los que 70 (54%) correspondieron a AAC (AP 38/70). El %N y la PCT obtuvieron un área ROC del 78% y el 80% para AAC (AP 76% y 81%), respectivamente. Un %N78.1% predijo AAC con una sensibilidad, una especificidad, un VPP y un VPN del 82%, 62%, 72% y 72% (74.9%, AP: 94%, 53%, 46% y 96%). Una PCT0.14 ng/dl predijo AAC con una sensibilidad, una especificidad, un VPP y un VPN del 69%, 79%, 80% y 68% (AP: 84%, 69%, 53% y 91%).El %N y la PCT constituyen biomarcadores útiles en el descarte de AP cuando se sospecha una apendicitis aguda.

Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

Background After appendectomy due to complicated acute appendicitis (CAA), there are some alternatives as antibiotic scheme: ciprofloxacin/metronidazole; as well as monoscheme based on carbapenems: ertapenem, meropenem, and imipenem. Aim This study aims to prove the efficacy of carbapenems versus ciprofloxacin/metronidazole in CAA post-operative management in terms of preventing complications during post-operative period and decreasing hospital stay. Materials and methods This was an observational, analytical, longitudinal, and prospective cohort study (March 2014-November 2016). Patients were classified into two groups, according to the prescribed antibiotic scheme: some carbapenems or ciprofloxacin/metronidazole. Results Ninety-eight patients were enrolled. There was an requirement for antibiotic therapy rotation only in the ciprofloxacin/metronidazole (7/49, 14.3%; p = 0.004). Carbapenems reached a mean hospital stay of 4.45 days, in contrast with ciprofloxacin/metronidazole, 8.29 days (p = 0.020). In post-surgical follow-up, there were more cases of curative resolution in the group in the carbapenems group (35/49 vs. 15/49 p < 0.001) as well as a greater number of cases with some late infection in the ciprofloxacin/metronidazole group (1/49 vs. 10/49, p = 0.010). Conclusion In the post-operative management of CAA, carbapenems represent an important indication to be considered as first-line antibiotic therapy.

Background and study aims Digital, per-oral cholangioscopy (POCS) allows diagnosis of biliary ducts disorders and treatment for complicated stones. We aimed to determine the diagnostic accuracy of digital POCS systems for stricture lesions and the factors precluding complete biliary stone clearance. Patients and methods We performed a retrospective analysis of a prospective database of 265 consecutive patients referred for POCS between December 2016 and July 2018. We first analyzed the diagnostic accuracy of digital POCS for malignant and benign stricture lesions in 147 patients. Then, we analyzed the factors associated with complete or partial biliary stone clearance achieved with electrohydraulic lithotripsy (EHL) delivered via POCS in 118 patients. Results In the diagnostic group, digital POCS achieved 91 % visual-impression sensitivity, 99 % specificity, 99 % positive and 91 % negative predictive values, and 63.64 positive and 0.09 negative likelihood ratios for malignancy diagnosis. In the therapeutic group, complete biliary stone clearance was achieved by EHL in 94.9 % patients; the mean stone size was 20 mm (10–40 mm). In multivariable analyses, a stone size > 20 mm (OR: 1.020, P Conclusions Digital POCS has excellent diagnostic efficacy for biliary lesions. EHL via POCS is effective for complicated biliary stone clearance. Stone size (> 20 mm) and the number of stones (≥ 3) are associated with partial biliary stone clearance.

Background and Aims Various macroscopic features are proposed for the diagnosis of biliary lesions during digital single-operator cholangioscopy (DSOC); however, neovasculature may be one of the most reliable features of neoplasia. We aimed to evaluate the detection of neovasculature during DSOC to distinguish neoplastic from non-neoplastic bile duct lesions. Methods A retrospective, single-center, cohort study was used. Neovasculature was defined as the presence of irregular or “spider” vascularity on bile duct lesions. The accuracy of detection of neovasculature for the identification of neoplastic lesions was estimated using the histologic results, surgical specimens, and/or 6-month follow-up as the criterion standard. Interobserver agreement analysis (kappa value) was performed between 2 expert endoscopists and 3 nonexpert physicians. Results Ninety-five patients were included; the median age was 65.6 years (range, 20-93 years), and 51 (53.7%) patients were female. Signs of neovasculature were observed in 65 of 95 (68.4%) patients. Histology confirmed neoplasia in 48 of 95 (50.5%) patients, and 6-month follow-up survival confirmed neoplasia in 52 of 95 (54.7%) patients. The use of vascularity for identifying neoplastic lesions achieved an accuracy of 80%, sensitivity of 94%, specificity of 63%, positive predictive value of 75%, negative predictive value of 90%, positive likelihood ratio of 2.53 (95% confidence interval, 1.71-3.76), and negative likelihood ratio of 0.09 (95% confidence interval, 0.03-0.28). The interobserver and intraobserver agreement were excellent (κ > 80%; P Conclusion Detection of irregular or spider vascularity on bile duct lesions during DSOC evaluations accurately identifies biliary neoplastic lesions. Prospective multicenter trials are required to evaluate neovasculature as a single factor for predicting neoplasia.

Background and aims Irritable bowel syndrome (IBS) is considered to be a functional disease, but recent data indicate measurable organic alterations. We aimed to determine the presence of colorectal mucosa microinflammation in vivo via probe-confocal laser endomicroscopy (pCLE) and histological evaluation in IBS patients. Methods This was a prospective, controlled, nonrandomized single-blind diagnostic trial performed in a tertiary institution. pCLE images and targeted biopsy of each colon segment obtained during colonoscopies of IBS patients and controls were analyzed for inflammatory changes. Biopsies were classified using the Geboes scale, and the odds ratio and overall diagnostic accuracy were calculated. Results During the 15-month study period, 37 patients were allocated to each group. The mean age was 53.1 ± 14.3 years; 64.9 % were female. Signs of colonic mucosa inflammation were evident on 65.8 % of pCLE images from IBS patients compared to 23.4 % of images from controls (OR 6.28; 4.14–9.52; P 0 was attributed to 60.8 % of biopsies from patients in the IBS group compared to 27.5 % of biopsies from the control group. The sensitivity, specificity, positive and negative predictive values, observed and interrater agreement of pCLE-detected inflammatory changes in IBS using histology as gold standard were 76 %, 91 %, 76 %, 91 %, 86.5 %, and 66.8 %, respectively. Conclusions Patients with IBS have a six-fold higher prevalence of colorectal mucosa microinflammation than healthy controls. pCLE might be a reliable method to detect colorectal mucosa microinflammation in IBS patients.

Background/aims Capsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain. Methods This study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups. Results Sixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (±standard deviation) age of 50.9±15.9 years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively. Conclusion Routine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.

In 1790-1791, the British sculptor Anne Seymour Damer (1749-1828) travels to Lisbon for health reasons. Damer describes the picturesque city and its environs in several letters to her friends back home, and she starts her novel Belmour (1801) in the Portuguese capital. This article analyses the realistic representation of Lisbon (as a place of recovery) and Sintra (as a space of evasion and sentimental learning) – through themes and narrative strategies such as religion, health recovery, the cultural Other and ethnographic and historical landscapes – in both the author’s letters and novel, which echo several contemporary British travel narratives about Portugal.

Psychiatric comorbidities are common in movement disorders. This review provides a practical approach to help clinicians to recognize psychiatric disorders in the most frequent movement disorders. However, the extent of neurodegeneration, as well as the impact of medications with considerable CNS effects, influences the diverse psychiatric presentations that, in turn, are influenced by the stress of living with a movement disorder. Depression, anxiety, and psychosis are the most common psychiatric comorbidities in movement disorders and of the medications used to treat the motor disturbances. These psychiatric problems impair patients' functioning throughout the course of the chronic neurodegenerative diseases. Due to the direct connection between brain dysfunction and psychiatric symptoms, there is hope that understanding the psychiatric comorbidities in movement disorders will lead to a better quality-of-life.

Effective hemostasis is essential to prevent rebleeding. We evaluated the efficacy and feasibility of the Over-The-Scope Clip (OTSC) system compared to combined therapy (through-the-scope clips with epinephrine injection) as a first-line endoscopic treatment for high-risk bleeding peptic ulcers. We retrospectively analyzed data of 95 patients from a single, tertiary center and underwent either OTSC (n = 46) or combined therapy (n = 49). The primary outcome of the present study was the efficacy of the OTSC system as a first-line therapy in patients with high-risk bleeding peptic ulcers compared to combined therapy with TTS clips and epinephrine injection. The secondary outcomes included the rebleeding rate, perforation rate, mean procedure time, reintervention rate, mean procedure cost and days of hospitalization in the two study groups within 30 days of the index procedure. All patients achieved hemostasis within the procedure; two patients in the OTSC group and four patients in the combined therapy group developed rebleeding (p = 0.444). No patients experienced gastrointestinal perforation. OTSC had a shorter median procedure time than combined therapy (11 min versus 20 min; p

GOALS The goal of this study was to evaluate the safety and feasibility of routine segmental retroflexed withdrawal viewing (RV) of the colon with the RetroView colonoscope. MATERIALS AND METHODS This was a prospective, single-center, 2-stage diagnostic trial. After cecal intubation, mucosal evaluation by forward viewing (FV) and RV was performed by segment (right, transverse, left, and sigmoid colon, and rectum). Lesions detected during FV were removed and/or marked before retroflexion. Safety and feasibility were measured through adverse event and technical success rates. All lesions detected and removed endoscopically were recorded. RESULTS Two hundred twenty-five patients underwent colonoscopy with the RetroView colonoscope. Retroflexion by segment was successful in the right, transverse, left, and sigmoid colon, and rectum in 98.9%, 100%, 100%, 82.6%, and 100% of cases, respectively. The mean total procedure time was 16.6 minutes. Ninety-four lesions were detected through retroflexion evaluation, for an increase in the lesions' detection rate of 30.7%. The per-adenoma miss rate of standard colonoscopy (FV) was 35.71%. The adenoma detection rate (ADR) for FV was 16%, whereas, when performing FV and RV, the ADR increased to 24.9%. Adverse events were recorded in 0.4% of cases. Therapeutic procedures were performed successfully through the retroflexed position in 81/225 patients. CONCLUSIONS Routine retroflexion evaluation of the colonic mucosa by segment using the RetroView colonoscope is safe and feasible. Retroflexion evaluation increases the detection rate of colonic lesions behind folds, including the number of adenomas per colonoscopy and ADR, offering a complete screening colonoscopy. All therapeutic procedures are feasible through retroflexion.

BACKGROUND: Bougies dilation is considered an effective technique for the treatment of simple benign esophageal strictures. The “rule of three” has been advocated to prevent reported adverse events such as bleeding and perforation. However, adherence to this rule has increased the cost and duration of treatment. OBJECTIVE: To demonstrate the safety and long-term benefits of progressive bougie dilations until reaching 15 mm (45Fr) in one single session endoscopy with non-adherence to the rule of three. METHODS: A retrospective analysis of a prospectively collected data of patients with simple benign esophageal strictures treated with multiple progressive bougie dilators until reaching 15 mm (45Fr) in one single session. RESULTS: The median age was 58 years (range 28-89), and 83.3% of patients were female. The main presenting symptom was dysphagia for solids in 11/12 cases (91.6%). The cause of their simple benign esophageal stricture was distributed as follows: 7/12 esophageal webs, 2/12 peptic stenosis, 2/12 Schatzki rings and one caustic injury. 75% required only one session for clinical success. No serious adverse events were described. No recurrence of symptoms was noted in a median follow-up of 20 months. CONCLUSION: The rule of three in patients with simple benign esophageal strictures secondary to esophageal webs, Schatzki rings and peptic strictures treated with Savary-Gilliard dilators is not necessary, showing good clinical results. Prospective studies with more patients are necessary. RESUMO CONTEXTO: A dilatação por velas é considerada uma técnica eficaz para o tratamento de estenoses esofágicas benignas simples. A “regra de três” tem sido defendida para prevenir eventos adversos relatados, como sangramento e perfuração. No entanto, a adesão a esta regra aumentou o custo e a duração do tratamento. OBJETIVO: Demonstrar a segurança e os benefícios de longo prazo das dilatações progressivas por velas até chegar a 15 mm (45Fr) em uma única sessão de endoscopia com não adesão à regra de três. MÉTODOS: Uma análise retrospectiva de dados coletados prospectivamente de pacientes com estenoses esofágicas benignas simples tratadas com múltiplos dilatadores de velas progressivas até atingir 15 mm (45Fr) em uma única sessão. RESULTADOS: A mediana de idade foi de 58 anos (variação de 28-89) e 83,3% dos pacientes eram do sexo feminino. O principal sintoma de apresentação foi a disfagia para sólidos em 11/12 casos (91,6%). A causa da estenose esofágica benigna simples foi distribuída como segue: 7/12 membranas esofágicas, 2/12 estenose péptica, 2/12 anéis de Schatzki e um ferimento cáustico. 75% necessitaram apenas de uma sessão para o sucesso clínico. Não foram descritos eventos adversos graves. Nenhum retorno dos sintomas foi anotado em uma continuação mediana de 20 meses. CONCLUSÃO: A regra de três em pacientes com as estenoses esofágicas benignas simples secundárias às membranas esofágicas, os anéis de Schatzki e as estenoses péptica tratadas com os dilatadores de Savary-Gilliard não é necessária, mostrando bons resultados clínicos. Estudos prospectivos com mais pacientes são necessários.

Em 1932, o marinheiro-escritor portugues Jaime do Inso (1880–1967) publica o romance de cariz etnografico O caminho do Oriente , que representa a viagem formativa de dois jovens rumo a Macau. O romance de Inso—que o autor descreve no prefacio como um patriotico “quadro ou esboco da nossa vida colonial” e que venceu o Concurso de Literatura Colonial de 1931—ficcionaliza a missao (inicialmente) comercial de Rodolfo e Frazao desde Lisboa rumo a misteriosa alteridade do territorio chines sob administracao portuguesa. A ideologia colonial impregna quer o olhar dos viajantes masculinos sobre o Oriente, quer a textualizacao de Macau por parte do narrador, que, tal como os protagonistas, tenta observar, descodificar e registar o Outro misterioso atraves da “poetica de espacos exoticos”. A par do estudo da morfologia e dos espacos culturais do enclave, analisaremos estrategias como: comentarios, digressoes ideologicas e descricoes de cariz etno-historiografico, a enumeracao, a intertextualidade, a comparacao e a descricao de paisagens visuais, acusticas e olfativas exoticas. Tal analise permitir-nos-a interpretar o Oriente indagado e textualizado, de forma subjectiva, pelas personagens, pelo narrador e pelo leitor ocidental que tambem apre(e)nde o caminho do Oriente, espaco-possibilidade sempre em aberto e desconhecido em Lisboa.