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1. Colonic complications following human bone marrow transplantation

Author

Paulino Martínez Hernández-Magro, Juan Pablo Peña Ruiz Esparza, Eduardo Villanueva Sáenz, José Luis Rocha Ramírez, Enrique Gómez Morales, and Isaac Felemovicius Hermagnus

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background: Human bone marrow transplantation (BMT) becomes an accepted treatment of leukemia, aplastic anemia, immunodeficiency syndromes, and hematologic malignancies. Colorectal surgeons must know how to determine and manage the main colonic complications. Objective: To review the clinical features, clinical and pathological staging of graft vs host disease (GVHD), and treatment of patients suffering with colonic complications of human bone marrow transplantation. Patients and methods: We have reviewed the records of all patients that received an allogeneic bone marrow transplant and were evaluated at our Colon and Rectal Surgery department due to gastrointestinal symptoms, between January 2007 and January 2012. The study was carried out in patients who developed colonic complications, all of them with clinical, histopathological or laboratory diagnosis. Results: The study group was constituted by 77 patients, 43 male and 34 female patients. We identified colonic complications in 30 patients (38.9%); five patients developed intestinal toxicity due to pretransplant chemotherapy (6.4%); graft vs. host disease was present in 16 patients (20%); 13 patients (16.8%) developed acute colonic GVHD, and 3 (3.8%) chronic GVHD. Infection was identified in 9 patients (11.6%). Conclusions: The three principal colonic complications are the chemotherapy toxicity, GVHD, and superinfection; the onset of symptoms could help to suspect the type of complication (0–20 day chemotherapy toxicity, 20 and more GVHD), and infection could appear in any time of transplantation. Resumo: Experiência: O transplante de medula óssea humana (MOH) passou a ser um tratamento adotado para leucemia, anemia aplástica, síndromes de imunodeficiência e neoplasias hematológicas. Cirurgiões colorretais devem saber como determinar e tratar as principais complicações do cólon. Objetivo: Revisar as características clínicas, estadiamentos clínico e patológico da doença do enxerto versus hospedeiro (DEVH) e o tratamento de pacientes padecendo com as complicações colônicas do transplante de medula óssea humana. Pacientes e Métodos: Revisamos os registros de todos os pacientes que receberam um transplante de medula óssea alogênica e foram avaliados em nosso Departamento de Cirurgia do Cólon e Reto em função de sintomas gastrointestinais, entre janeiro de 2007 e janeiro de 2012. O estudo teve por base os pacientes que desenvolveram complicações do cólon, todos com diagnóstico clínico, histopatológico ou laboratorial. Resultados: O grupo de estudo foi constituído por 77 pacientes, sendo 43 homens e 34 mulheres. Identificamos complicações do cólon em 30 pacientes (38,9%); cinco pacientes exibiam toxicidade intestinal por quimioterapia antes do transplante (6,4%); DEVH estava presente em 16 pacientes (20%), 13 pacientes (16,8%) foram acometidos por DEVH colônica aguda três pacientes (3,8%) DEVH crônica. Infecção foi detectada em 9 pacientes (11,6%). Conclusões: As três principais complicações do cólon são: toxicidade por quimioterapia, DEVH e superinfecção. O surgimento dos sintomas poderia ajudar a levantar suspeitas sobre o tipo de complicação (0–20 dias, toxicidade por quimioterapia; 20 ou mais dias, DEVH). Infecções podem ocorrer em qualquer momento do transplante. Keywords: Colonic complications, Human bone marrow transplantation, Superinfection, Palavras-chave: Complicações do colo, Transplante de medula óssea humana, Superinfecção

Published
2015
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8. Prevalencia de dolor en pacientes hospitalizados en Unidad de Cuidados Intensivos Metabólicos con intubación orotraqueal y bajo sedación, medido con escala COMFORT

Author

García-Ramírez, P.E., Valenzuela-Molina, L.C., Zazueta-Araujo, E., López-Morales, C.M., Cabello-Molina, R., and Martínez-Hernández-Magro, P.

Subjects
sedation, terapia intensiva, intensive therapy, Pain, Dolor, intubación, intubation, sedación
Abstract

RESUMEN Introducción: El dolor es un padecimiento frecuente en pacientes hospitalizados en unidades de cuidados intensivos, sin embargo es subdiagnosticado en aquellos pacientes que no tienen la capacidad para expresarlo. Diversas escalas se han validado a nivel mundial para determinar el nivel de dolor en dichos pacientes, pero existe poco personal entrenado para aplicarlas y escasos estudios sobre prevalencia de dolor en UCI. Objetivos: Se determina la prevalencia de dolor en pacientes hospitalizados en la Unidad de Cuidados Intensivos Metabólicos (UCIM) orointubados y bajo sedación. Material y métodos: Estudio de cohorte, descriptivo, observacional y prospectivo. Fueron incluidos todos los pacientes hospitalizados en UCIM que cumplen con los criterios de inclusión (pacientes orointubados bajo sedación). Resultados: Se incluyeron 36 pacientes, siendo el 77,7 % del sexo masculino. La edad osciló entre 18 y 71 años con media de 51 y desviación estándar de 14,05. El 86 % de los pacientes ingresó por patología quirúrgica y el 75 % se encontraba con politerapia analgésica. La prevalencia de dolor medido con escala COMFORT fue del 69,4 %. Conclusión: La prevalencia de dolor en pacientes intubados y bajo sedación endovenosa en la UCIM es similar a la reportada en la literatura, siendo el nivel de sedación el factor que más se correlaciona de manera significativa con una mayor intensidad de dolor. ABSTRACT Introduction: Pain is common in hospitalized patients in intensive care condition; however, it is underdiagnosed in patients who are unable to express it. Multiple scales have been validated worldwide to determine the level of pain in these patients; however there are a few trained personnel to apply them as well as lack of medical information about prevalence of pain in ICU. Objectives: To determine prevalence of pain in hospitalized patients at the Metabolic Intensive Care Unit, with oral intubation and under sedation. Methods: Cohort study, descriptive, observational and prospective. Including all patients hospitalized in UCIM with oral intubation plus sedation, fulfilling inclusion criteria. Results: A total of 36 patients were included, 77.7 % were male. Age ranged between 18 and 71 years old with 51 in average and standard deviation of 14.05. 86 % of patients were admitted for surgical pathology and 75 % were treated with analgesic combination therapy. Prevalence of pain measured with COMFORT scale was 69.4 %. Conclusion: Prevalence of pain in our intubated patients under intravenous sedation is same to that reported in the literature, with level of sedation as a main factor associated to increase the presence of pain.

Published
2018

10. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Author

Wright, Naomi Jane, Leather, Andrew J.M., Ade-Ajayi, Niyi, Sevdalis, Nick, Davies, Justine, Poenaru, Dan, Ameh, Emmanuel, Ademuyiwa, Adesoji, Lakhoo, Kokila, Smith, Emily Rose, Douiri, Abdel, Elstad, Maria, Sim, Marcus, Riboni, Cristiana, Martinez-Leo, Bruno, Akhbari, Melika, Tabiri, Stephen, Mitul, Ashrarur, Aziz, Dayang Anita Abdul, Fachin, Camila, Niyukuri, Alliance, Arshad, Muhammad, Ibrahim, Fowzia, Moitt, Natalie, Doheim, Mohamed Fahmy, Thompson, Hannah, Ubhi, Harmony, Williams, Isabelle, Hashim, Sophia, Philipo, Godfrey Sama, Herrera, Laura, Yunus, Aayenah, Vervoort, Dominique, Parker, Samuel, Benaskeur, Yousra-Imane, Alser, Osaid H., Adofo-Ansong, Nana, Alhamid, Ahmad, Salem, Hosni khairy, Saleh, Mahmoud, Elrais, Safa Abdal, Abukhalaf, Sadi, Shinondo, Patricia, Nour, Ibrahim, Aydin, Emrah, Vaitkiene, Agota, Naranjo, Kelly, Dube, Andile Maqhawe, Ngwenya, Sodumisa, Yacoub, Mina A., Kwasau, Henang, Hyman, Gabriella, Elghazaly, Shrouk Mahmoud, Al-Slaibi, Ibrahim, Hisham, Intisar, Franco, Helena, Arbab, Hana, Samad, Lubna, Soomro, Aqil, Chaudhry, Muhammad Amjad, Karim, Safina, Khattak, Muhammad Adnan Khan, Nah, Shireen Anne, Dimatatac, Doris Mae, Choo, Candy SC, Maistry, Niveshni, Mitul, Ashrarur Rahman, Hasan, Samiul, Karim, Sabbir, Yousuf, Hina, Qureshi, Taimur, Nour, Ibrahim Rabi, Al-Taher, Raed Nael, Sarhan, Osama Abdul Kareem, Garcia-Aparicio, Luis, Prat, Jordi, Blazquez-Gomez, Eva, Tarrado, Xavier, Iriondo, Martí, Bragagnini, Paolo, Rite, Segundo, Hagander, Lars, Svensson, Emma, Owusu, Sheila, Abdul-Mumin, Alhassan, Bagbio, Dominic, Ismavel, Vijay Anand, Miriam, Ann, T, Shajin, Anaya Dominguez, Marlene, Ivanov, Monica, Serban, Andreea Madalina, Derbew, Miliard, Elfiky, Mahmoud, Olivos Perez, Maricarmen, Abrunhosa Matias, Marcia, Arnaud, Alexis P, Negida, Ahmed, King, Sebastian, Fazli, Mohamad Rafi, Hamidi, Nadia, Touabti, Souhem, Chipalavela, Rossana Francisco, Lobos, Pablo, Jones, Brendan, Ljuhar, Damir, Singer, Georg, Hasan, Samiul, Cordonnier, Annelien, Jáuregui, Lorena, Zvizdic, Zlatan, Wong, Janice, St-Louis, Etienne, Shu, Qiang, Lui, Yang, Correa, Catalina, Pos, Lucie, Alcántara, Elvyn, Féliz, Erick, Zea-Salazar, Luis Enrique, Ali, Liza, Peycelon, Matthieu, Anatole, Nzanzu Kipata, Jallow, Cherno S., Lindert, Judith, Ghosh, Dhruv, Adhiwidjaja, Cathline Freya, Tabari, Ahmad Khaleghnejad, Lotfollahzadeh, Saran, Mussein, Haidar Mohammad, Vatta, Fabrizio, Pasqua, Noemi, Kihiko, David, Gohil, Hetal, Nour, Ibrahim R., Elhadi, Muhammed, Almada, Suad Ahmed, Verkauskas, Gilvydas, Risteski, Toni, Peñarrieta Daher, Alejandro, Outani, Oumaima, Hamill, James, Lawal, Taiwo, Mulu, Jack, Yapo, Benjamin, Saldaña, Lily, Espineda, Beda, Toczewski, Krystian, Tuyishime, Eugene, Ndayishimiye, Isaac, Raboe, Enaam, Hammond, Philip, Walker, Gregor, Djordjevic, Ivona, Chitnis, Milind, Son, Joonhyuk, Lee, Sanghoon, Hussien, Muaad, Malik, Sawazen, Ismail, Enas Musa, Boonthai, Ampaipan, Dahman, Nesrine Ben Hadj, Hall, Nigel, Castedo Camacho, Fabiola Ruth, Sobrero, Helena, Butler, Marilyn, Makhmud, Aliev, Novotny, Nathan, Hammouri, Ahmad G., Al-Rayyes, Maisara, Bvulani, Bruce, Muraveji, Qais, Murzaie, Muhammad Yousuf, Sherzad, Ajmal, Haidari, Sayed Aman, Monawar, Abdul Baqi, Samadi, Dr. Ahmad Zia, Thiessen, Jesh, Venant, Ntakarutimana, Hospital, Sonia Inamuco, Jérémie, Niyonkuru, Mbonicura, Jean Claude, Vianney, Butoyi Jean Marie, Tadesse, Amezene, Negash, Samuel, Roberts, Charles A., Jabang, John N., Bah, Abdoulie, Camamra, Kajali, Correa, Armandou, Sowe, Babucarr, Gai, A., Jaiteh, Musa, Raymond, Kwizera Jean, Mvukiyehe, Jean Paul, Itangishaka, Innocent, Kayibanda, Emmanuel, Manirambona, Emery, Lule, Joseph, Costas-Chavarri, Ainhoa, Shyaka Gashugi, Ian, Ndata, Albert, Gasana, Georges, Nezerwa, Yves Castar, Simeon, Turatsinze, Muragijimana, Jean De Dieu, Rashid, Sakina, Msuya, David, Elisante, Joseph, Solanki, Meghna, Manjira, Emmanuel, Lodhia, Jay, Jusabani, Mubashir, Tarmohamed, Murad, Koipapi, Sengua, Souhem, Touabti, Sara, Nabti, Sihem, Brahimi, Dania, Bouguermouh, Toufik, Iaiche Achour, Mounira, Baghdadi Nour el islam, Habiba, Alouani, Aragão, Liliana, Gonçalves, Victor, Lino Urquizo, Marcelo Mauricio, Varela, Maria Florencia, Mercado, Pedro, Horacio, Bonavia, Damiani, Andrea, Mac, Carlos, Putruele, Daniel, Liljesthrom, Karen, Bernaus, Marianela, Jauri, Cesar, Cripovich, Alejandrina, Bianchin, Ezequiel, Puig, Maria Gabriela, Andreussi, Lorna, Iracelay, Susana, Marcos, Dolores, Herrera, Carina, Palacios, Nelly, Avile, Romina, Serezo, Belen, Montoya, Debora, Cepeda, Rodrigo, Vaquila, Justo, Veronica, Sofficci, Pardo, Liliana, Valeria, Pelussi, Julio, Lapalma, Martin, Aranda Diego, Lucio, Palazzi, Gabriel, Comba, Marianella, Depetrini, Calderón Arancibia, José Alfredo, Huespe, Enrique, Losa, Gabriela Natalia, Arancibia Gutiérrez, Elsa, Scherl, Humberto, Gonzalez, Daniel Emilio, Baistrocchi, Valentina, Silva, Yanina, Galdeano, Marcelo, Medard, Pablo, Sueiras, Ines, Romero Manteola, Enrique, Defago, Victor Hugo, Mieres, Carlos, Alberto, Carlos, Cornelli, Fabio, Molina, Marcelo, Ravetta, Pablo, Patiño Gonzalez, Celeste Carolina, Dallegre, Maria Belen, Szklarz, Maria Tatiana, Leyba, Marcos Federico, Rivarola, Nahuel Ignacio, Charras, Maria Delia, Morales, Adriana, Caseb, Paloma, Toselli, Luzia, Millán, Carolina, Junes, Maria del Carmen, Di Siervi, Oscar, Gilardi, Jose, Simon, Soledad, Contreras, Carla Sofia, Rojas, Nair, Arnoletto, Lucia Beatriz, Blain, Otilia Eva, Bravo, Mauro Nicolas, Sanchez, Nancy, Herrera Pesara, Luciana Martina, Moreno, Maria Eugenia, Sferco, Carlos Ariel, Huq, Umama, Ferdousi, Tamanna, Al-Mamun, Abdullah, Sultana, Sadia, Mahmud, Refoyez, Mahmud, Khalid, Sayeed, Fatema, Svirsky, Alexander, Sempertegui, Denisse, Negrete, Amalia, Teran, Araceli, Sadagurschi, Mariana, Popovic, Nusret, Karavdic, Kenan, Milisic, Emir, Jonuzi, Asmir, Mesic, Amira, Terzic, Sabina, Dendusic, Nejra, Biber, Elna, Sehic, Anesa, Zvizdic, Nada, Letic, Emina, Saracevic, Adna, Hamidovic, Ajla, Selak, Nejra, Horozic, Dzan, Hukic, Lamija, Muhic, Amila, Vanis, Nedim, Sokolovic, Emir, Sabic, Adnan, Becker, Karin, Novochadlo Klüppel, Elis, dos Santos Dias, André Iván Bradley, Agulham, Miguel Angelo, Bischoff, Cristiano, Sabbatini, Stella, Fernandes de Souza, Rachel, Souza Machado, Ana Beatriz, Werneck Raposo, Juliana, da Silva Augusto, Maria Lucia, Martins, Bianca M.R., de Souza Santos Ferreira, Mariana, Fernandes de Oliveira, Darli, Silva dos Santos, Carla, Ribeiro de Fernández y Alcázar, Fernanda, Alves Dutra da Silva, Érika, Furtado, Mariana, Tamada, Horácio, Silva Ferreira dos Santos, Marília, Lopes de Almeida, Thayná, Oliveira de Andrade, Susy, Gurgel do Amaral, Antonio Cipriano, Sartori Giovanoni, Lais, de Deus Passos Leles, Kamila, Corrêa Costa, Eduardo, Feldens, Leticia, Ferraz Schopf, Luciano, Soares de Fraga, José Carlos, Colombo de Holanda, Felipe, Brolin Santis Isolan, Paola Maria, Loyola Ferreira, Julia, Bruxel, Carla Luisa, Lopes Teixeira Ferdinando, Danielle, Zottis Barcelos, Fabricio, Baseggio, Natalia, Knorr Brenner, Nicole, Trindade Deyl, Rafael, Dure, Carolina, Nunes Kist, Iuri, Bueno Mazzuca, Rafael, Bueno Motter, Sarah, Ramos, Yna, Suzana Trein, Cristine, Rezende Rosa, Bianca, de Assis Silva, Murilo, Menin, Flavio Augusto, Semensato Carloni, Isabela Cristina, Norberto da Silva, Juliana Antinarelli, Gomes, Adriano Luis, Girão Tauffer, Mariana, Bassan Gonçalves, Paulo César, Nogueira Marques, Geraldo Magela, Moriya, Eliane, Labonia, Carla, Carrasco, Ana Lucia, Furtado Meyer, Karine, Farion-Aguiar, Luiz, Amado, Fernando, Antunes, Amanda, Silva, Elisângela, Telles, Leila, Almeida, Giovana, Belmino Gadelha, Aluísio Augusto, de Azevedo Belesa, Flavia, Gonçalves da Cunha, Acimar, Jr, Souza Barros, Beatriz, Zanellato, Josiane Bernartt, Guimarães, Patricia, Silva, Karina Ilheu da, Ribas, Bianca, Reuter, Cristina, Casado, Francis Tanise, Correa Leite, Mila Torii, Testoni, Daniela, Guinsburg, Ruth, de Campos Vieira Abib, Simone, Khodor Cury, Edson, Dornellas do Nascimento, Suely, Almeida Aguiar, Arthur, Melo Gallindo, Rodrigo, Gonçalves Borges, Carolina, Liu, Yang, Duote, Cai, Wang, Jinhu, Gao, Zhigang, Liang, Liang, Luo, Wenjuan, Zhao, Xiaoxia, Chen, Rui, Wang, Peng, Han, Yijiang, Huang, Ting, Donglai, Hu, Xiaodong, Guo, Junjie, Chen, Zhu, Libin, Wu, Guowei, Bao, Xiaozhou, Li, Haijing, Lv, Junying, Li, Zhongrong, Yong, Feng, Gao, Zhou Chong, Bai, Qiang, Tang, Weibing, Xie, Hua, Motee, Jethishka, Zhu, Jianming, Wen, Gang, Ruan, Weiwei, Li, Shungen, Chen, Lulu, Huang, Shungen, Lv, Zhibao, Lu, Jinjing, Huang, Liuming, Yu, Mengnan, Dajia, Wang, Bai, Yu Zuo, Rincon, Luis Carlos, Mancera, Juliana, Alzate Gallego, Edgar, Torres-Canchala, Laura, Silva Beltrán, Nathalia, Osorio Fory, Ghordana, Castaño Avila, Daniela, Forero Ladino, Angelica Maria, Gomez, Juanita, Jaramillo, Martha, Morales, Otto, Sanchez, Beatriz, Tinoco Guzmán, Nestor Julien, Castañeda Espinosa, Sergio, Prieto Vargas, Osbaldo, Pardo, Lina Maria, Toral, Eliana, Cáceres Aucatoma, Freud, Hinostroza, Daniel, Valencia, Santiago, Salinas, Vicente, Landivar Cino, Enrique, Ponce Fajardo, Gabriela Yulissa, Astudillo, Miguel, Garcia, Virginia, Muñoz, Guillermo, Verduga, Leonardo, Verduga, Ivan, Murillo, Ericka, Bucaram, Elena, Guayelema, Marisol, Marmol, Monica, Sanchez, Janina, Vergara, Carolina, Mena, Adriana, Velaña, Junior, Salazar, Karla, Lara, Sandra, Chiriboga, Elena, Silva, Julian, Gad, Dalia, Samy, Doaa, Elsadek, Menan Ahmed, Mohammed, Hanan Mahmoud, Abouheba, Mohamed, Ali, Karim Osamy, Rashwan, Hayssam, Fawzy, Omar Moustafa, Kamel, Tarek mohamed, Nemer, Rawan, Hassan, Mohamed Abada, Falah, Eyad Hassan, Abdelhady, Dina Sobhy, Zain, Mostafa, Ibrahim, Eman Abouzeid Abouzeid, Elsiraffy, Omar Ossama, Aboelela, Ahmed, Farag, Eman mohamed, Oshiba, Ahmed Mohamed, Emam, Omar Sameh, Attia, Alaa Mobarak, Laymouna, Moustafa A., Ghorab, Islam Abdelmonem, Mohammed, Mansour Mkayed, Soliman, Nourhan Akram, Ghaly, Khaled Abd elrahman, Sadek, Kareem, Elsherbiny, Mohamed, Saleh, Amr, Sheir, Hesham, Wafa, Tamer, Elmenam, Mohamed Abd, Abdelmaksoud, Sherif, Reda, Ahmed, Mansour, Islam, Elzohiri, Mohamed, Waseem, Basma, Elewaily, Mohamed, El-Ghazaly, Mohammed, Elhattab, Ahmad, Shalaby, Amr, Elsaied, Adham, Adawy, Ahmad, Sadek, Mirna, Ahmed, Mahmoud Abdelfattah, Herdan, Mohamed Omar, Elassall, Gena Mohamed Hamed, Mohammed, Azhar Arabi, Takrouney, Mohammed Hamada, Essa, Tarek Mohamed, Mahmoud, Ahmed Mokhtar, Saad, Alshaimaa M., Fouly, Mariam Albatoul Nageh, Ibrahim, Mahmoud abdelshakour, Nageh, Mohammad, Saad, Mahmoud M., Badr, Helmy, Fouda, Mohamed Fayez, Nofal, Ahmed Hassan, Almohamady, Hisham, Arafa, Mohamed Ahmed, Amad, Mohamed, Mansour, Mohamed Awad, O'Connor, Jennifer, O'Connor, Zachary, Anatole, Nzanzu, Nkunzimana, Elysé, Machemedze, Solomon, Dieudonné, Lemfuka, Appeadu-Mensah, William, Anyomih, Theophilus Teddy Kojo, Alhassan, Priscilla, Abantanga, Francis A., Michael, Vishal, Mary Koshy, Roshine, Raj, Ankit, Kumar, Vijay, PT, Sundeep, Prabhu, P Santosh, Vosoughi, Armin, Al-Mayoof, Ali Farooq, Fadhle, Muhamed Jassim, Joda, Ali Egab, Algabri, Hayder Nadhim Obaid, Al-Taher, Raed Nael, Abdelhamid, Sultan S., Al-Momani, Hashem M., Amarin, Marzouq, Zaghlol, Louay Y., Alsaadi, Nijmeh Nasser, Qwaider, Yasmeen Z., Qutishat, Hibah, Aliwisat, Ahmad Hasan, Arabiat, Esraa, Bsisu, Isam, Murshidi, Raghad M., Jabaiti, Mohammad S., Bataineh, Ziad A., Abuhayyeh, Husam Aldean, Quran, Thekraiat M. Al, Za'nouneh, Faris J. Abu, Alebbini, Mohanad Mutasem, Qudah, Hamzah Abullah, Hussein, Omar Ghazi, Murad, Amir M.I., Amarin, Justin Z., Suradi, Haya H., Alzraikat, Sayel H., Omari, Rand Y., Matour, Bashar M., Al-Halbouni, Layana, Zurikat, Rajai O., Yanis, Ahmad H., Hussein, Sara Al, Shoubaki, Ali, Ghanem, Waleed H., David, Kuria, Chitiavi, Soita Wycliffe, Mose, Moraa, Mugo, Robert, Ndungu, James, Mwai, Timothy, Shahbal, Swaleh, Malik, Janan, Chauhan, Nirav, Syovata, Francisa, Ochieng, Kevin, Omendo Liyenzero, Polycarp, Hussain, Syeda Ra'ana, Mugambi, Stanley, Ochieng, Roseline, Elkhazmi, Ebtesam Othman Abdulsalam, Khaled, Ala, Albozidi, Aya, Enbaya, Manal Ben, Elgammudi, Mala, Soula, Enas, Khalel, Wegden ibrahim almabrouk, Elhajjaji, Yasmine Ali, Alwaggaa, Nouriyah Ali, Ghayth, Sumayyah, Zreeg, Dafer abdulhakim .S., Tantush, Sara Abobaker, Bibas, Fatma, Layas, Tesneem, Sharif, Randa Alamen M, Aljadidi, Wesal Omar F. Saied, Tarek, Ahmed, Ahmed, Hazem, Essamilghi, Kamila Almabrouk Mohammed, Alfoghi, Mabroka, Abuhlega, Ma'aly A., Arrmali, Saddam, Abduljawad, Fatima Mousa, Alosta, Hasan Mustafa, Abuajaila, Abdulsalam, Abdelmutalib, Fakereldeen, Bashir, Fatma, Almengar, Inas, Annajjar, Mohammad hasan, Deyab, Abdelaziz, Elzowawi, Fathi, Krayem, Yousef, Drah, Weam, Meftah, Asma, Mohammed, Abobaker, Arrmalli, Lina Ali, Aljaboo, Hajir, Elayeb, Abdallah, Altomi, Mohamed, Altaweel, Ahmed, Tumi, Mohamed, Bazozi, Hana Milad, Shaklawoon, Aisha, Alglaib, Mohammed Meftah, Elkaloush, Abdullahn Abdousalam, Trainba, Sara, Swessi, Hisham, Alnaeri, Ali, Shnishah, Aya Essam, Mustufa, Hamassat, Gargum, Sondas Ali, Tarniba, Sara Ali, Shalluf, Hawa Ahmed, Shokri, Hajer Ali, Sarkaz, Taher L., Tababa, Osama, Elhadi, Ahmed, Naunova, Vesna Cvetanovska, Jovcheski, Laze, Kamilovski, Marjan, Gavrilovska-Brzanov, Aleksandra, Latiff, Zarina Abdul, Pauzi, Siti Farhan Moh, Osman, Marjmin, Lim, Felicia, Bakar, Ainal Huda Abu, Zaman, Azrina SK, Ishak, Shareena, Teo, Rufinah, Qi, Dr. Tammy Teoh Han, Othman, Mohd Yusran Bin, Zahari, Dato' Dr Zakaria bin, Hassan, Zulfitri bin Md, Shan, Cheah Hui, Lechmiannandan, Abhirrami, Tamaddun, Hafatin Fairos bt, Adanan, Mohd Fitri Shukri bin Mohamed, Abdullah, Mohd Yusof bin, Junyi, Wang, Nor, Mohd. Tarmizi Mohd, Noor, Wan Ruzaimie, Hassan, Mohd Razin bin, Dalek, Noor Fa'izatul Rahil Ambok, Hashim, Hidayah Hayati binti, Zarwawi, Ahmad Zulhisyam bin, Vellusamy, V Muthualhagi M, Yuen, Quah Soong, Kannessan, Hemasutha a/p, Ramli, Najua binti, Bujarimin, Ahmad Shafiee bin, Anntinea, Jessmine, Dass, Anthony, Khalid, Hazlina Mohd., Hanifah, Nur Atiqah binti Mohd, Jyun, Keily Wong Yue, Razak, Rahilah binti Abd, Naim, Nur Atifah binti Mohd, Hamzah, Siti Nur Aien binti Hamid, Vidal, Cristian R. Zalles, Bracho Blanchet, Eduardo, Dávila Perez, Roberto, Fernandez Portilla, Emilio, Villegas Silva, Raúl, Ibarra, Daniel, Calderon Moore, Antonio, Carrasco-Ortega, Cesar, Noguez Castillo, Monica, Herappe Mellado, Dorihela, Yanowsky Reyes, Guillermo, Gonzalez Cortez, Luis Fernando, Santana Ortiz, Rafael, Orozco Perez, Jamie, Corona C.Rivera, Jorge Román, Cardenas Ruiz Velasco, Juan Jose, Quiles Corona, Moises, Peña Padilla, Christian, Bobadilla Morales, Lucina, Corona Rivera, Alfredo, Rios Flores, Izabel Maryalexandra, Aranda Sánchez, Cristian Irela, Ambriz-González, Gabriela, Martínez Hernández Magro, Nestor, León Frutos, Francisco Javier, Cárdenas Barón, José de Jesús, González Ojeda, Alejandro, Yarza Fernández, Jessica, Porras, Juan Domingo, Aguirre-Lopez, Pastor, Sánchez Paredes, Vicente, Montalvo Marin, Arturo, Diaz Gomez, Jose Manuel, Caamal, Lorenzo Juvencio, Bulnes Mendizabal, David, Sanchez Valladares, Pablo, Garcia Martinez, Humberto, Adesanya, Opeoluwa, Olanrewaju, Moses, Adegboyega, Rilwan, Abdulraheem, Nurudeen, Aremo, Anuoluwapo, Dedeke, Florence, Chukwuemeka, Anyanwu Lofty-John, Mohammad, Mohammad Aminu, Lawalbarau, Abdullahi, Collins, Nwokoro, Ibukunolu, Ogundele, Shonubi, Amo, Ladipo-Ajayi, Oluwaseun, Elebute, Olumide Abiodun, Seyi-Olajide, Justina, Alakaloko, Felix, Ihediwa, George, Olayade, Kayode, Bode, Christopher, Ogundoyin, Olakayode, Olulana, Dare I., Egbuchulem, Ifeanyichukwu Kelvin, Kumolalo, Felix O., Ulasi, Ikechukwu, Ezomike, Uchechukwu Obiora, Ekenze, Sebastian Okwuchukwu, Nwankwo, Elochukwu Perpetua, Nwangwu, Emmanuel Ifeanyi, Chukwu, Isaac, Amah, Christopher Chim, Obianyo, Nene Elsie, Williams, Omolara, Osuoji, Roland Iheanyichukwu, Faboya, Omolara Moronkeji, Ajai, Olalekan Temitope, Abdulsalam, Moruf Adekunle, Agboola, Titiloye Hannah, Temilade, Bolarinwa Bolanle, Osazuwa, Maryrose, Salawu, Morayo Monsurat, Ejinkeonye, Eze Chukwuemeka, Yola, Mariya Mukhtar, Mairami, Amsa B., Otuneye, Adekunle T., Igoche, Matthias, Tanimola, Adebayo Gbenga, Ajao, Emmanuel Akinlabi, Agelebe, Efeturi, Olori, Samson, Mshelbwala, Philip Mari, Osagie, Olabisi, Oyinloye, Adewale, Abubakar, Auwal M, Oyebanji, Lateef, Shehu, Ibrahim, Cletus, Cyril, Bamanga, Ahmed, Suleiman, Faruk, Adamu, Sani, C.Nwosu, David, S.Alkali, Yahya, Jalo, Iliya, Rasaki, Aliu, T.Sambo, Yusuf, A.Mohammed, Kalakwa, M.Ballah, Abubakar, Modekwe, Victor, Ekwunife, Okechukwu Hyginus, Ezidiegwu, Ugochukwu S, Osuigwe, Andrew N, Ugwu, Jideofor O, Ugwunne, Chuka A, Akhter, Nadeem, Gondal, Mudassir Fayaz, Raza, Rafee, Chaudary, Ali Raza, Ali, Hassan, Nisar, Muhammad Umar, Jamal, Muhammad Umer, Pandit, Ghuri Shankar, Mumtaz, Uzma, Amjad, Muhammad Bin, Talat, Nabila, Rehman, Wajeeh ur, Saleem, Muhammad, Mirza, Muhammad Bilal, Hashim, Imran, Haider, Naveed, Hameed, Soban, Saleem, Ayesha, Dogar, Sohail, Sharif, Muhammad, Bashir, Muhammad Kashif, Naumeri, Fatima, Rani, Zarqa, Baniowda, Muath A.M., Ba'baa', Basheer, Hassan, Majd Yousef Mohammed, Darwish, Ammar, Sehwiel, Abrar Shaheen, Shehada, Mohammed, Balousha, Abrar ghassan, Ajrami, Yara, Alzamari, Ainaa Ata Mohammad, Yaghi, Bashar, Al-saleem, Hasan Subhi Hasan Abu, Farha, Mervat Sufian Abu, Abdelhafez, Mohammad Omar Mohammad, Anaya, Firas, Qadomi, Asef belal, Odi, Abd Al-Naser Bany, Assi, Muath Abdelrahem Fuad, Sharabati, Fadwa, Abueideh, Ahmad, Beshtawi, Doha mustafa saleh, Arafat, Hasan, Khatatba, Lara Zahi Adel, Abatli, Safa' Jamal, Al-Tammam, Hiba, Jaber, Dania, Kayed, Yara Imad Omar, Abumunshar, Ali Abdelhay, Misk, Rami Anwar, Alzeer, Asmahan Mohammad Suliman, Sharabati, Mutassem, Ghazzawi, Ihsan, Darras, Osama Majed, M.Qabaja, Mahmoud, Hajajreh, Ma'alem sameer, Samarah, Yasmeen Ahmad, Yaghi, Dua Hasan, Qunaibi, Moradallah Asad Fahmi, Mayaleh, Abdelrazzaq Abu, Joubeh, Sharehan, Ebeido, Annan, Adawi, Samer, Adawi, Ihda, Alqor, Mohammad Omar Ibrahim, Arar, Ahmad Samih, Awad, Hadeel, Abu-Nejmah, Fawzi, Shabana, Osaid Shaher, Alqarajeh, Firas, Alzughayyar, Tareq Z., Madieh, Jomana, Sbaih, Mahmoud Fuad, Alkareem, Raghad mohammad abdu, Lahlooh, Raghad abdullateef, Halabi, Yasmeen Adly, Baker, Wisam, Almusleh, Tasneem Fathi Hasan, Tahyneh, Abdulraheem Adnan Abdulraheem, Atatri, Yazid yousef mahmoud, Jamie, Najlaa Abu, Massry, Nasrallah Ashraf Al, Lubbad, Walaa, A.Nemer, Ayoub, Alser, Mohammed, Salha, Aya Azmi Shehda, Alnahhal, Khaled, Elmzyyen, Aya Mahmoud, Ghabayen, Amir Talat Sheda, Alamrain, Abdulwhhab Ayman Abu, Al-Shwaikh, Samar H., Elshaer, Omar Adly, Shaheen, Nureddin, Fares, Jehad, Dalloul, Hisham, Qawwash, Anas, Jayyab, Mustafa abu, Ashour, Dina Ayman, Shaheen, Ahmad Ashraf, Naim, Samy Rafat Ramadan, Shiha, Eman Abu, Dammagh, Nagham Mohammed Al, Almadhoun, Walaa, Al-Salhi, Ashraf Ayman, Hammato, Abdalkarim Yhya, Salim, Jamal Mohammed, Hasanain, Doaa Khalil, Alwadia, Soha Marwan Salem, Nassar, Ismail, Al-Attar, Hala M., Alshaikhkhalil, Haya Abdulnasser Ali, Jamie, Yasmin Mohammed Khalil Abu, Ashour, Yara shareef, Alijla, Sharif S., Tallaa, Mohamed Anwer El, Abuattaya, Adham Ashraf, Wishah, Bisan D.M., ALDIRAWI, MOHAMMED A.M., Darwish, Ahmed S, Alzerei, Sulaiman T., Wishah, Nidal, Alijla, Sharif, Garcia, Isidora, Diaz Echegaray, Marlene, Cañapataña Sahuanay, Veronica Raquel, Trigoso Mori, Fernando, Alvarado Zelada, Jackelyne, Salinas Barreto, Juan Jose, Rivera Altamirano, Porfirio, Torres Miranda, Cesar, Anicama Elias, Rocio, Rivera Alvarez, Julio, Vasquez Matos, Juan Pedro, Ayque Rosas, Fernando, Ledesma Peraza, Jesmarina, Gutarra Palomino, Andrea, Vega Centen, Stephany, Casquero, Victor, Ortiz Argomedo, María Rosa, Lapouble, Francisco, Llap Unchón, Genaro, Delgado Malaga, Florangel Patricia, Ortega Sotelo, Luis, Gamboa Kcomt, Segundo, Villalba Villalba, Araceli, Mendoza Leon, Nancy Rossana, Cardenas Alva, Loreley Raquel, Loo Neyra, Maria Susana, Alanguia Chipana, Cathy Lee, Torres Picón, Cintya Maria de Jesus, Huaytalla Quiroz, Natalia, Dominguez, Danny, Segura Calle, Carlos, Arauco, Jenny, Ormeño Calderón, Luis, Ghilardi Silva, Ximena, Fernandez Wilson, Miriam Daniela, Gutierrez Maldonado, Joan Elizabeth, Diaz Leon, Cesar, Berrocal Anaya, Waldo, Chavez Galvez, Patricia, Aguilar Gargurevich, Prince Pamela, Diaz Castañeda, Flor de Maria, Guisse, Carmen, Ramos Paredes, Erika, Apaza Leon, Jose Luis, Aguilar Aguilar, Faye, Ramirez De La Cruz, Raul, Flores Carbajal, Lenny, Mendoza Chiroque, Carlos, Sulca Cruzado, Gladys Johana, Tovar Gutierrez, Natalia, Sotelo Sanchez, Jennifer, Paz Soldan, Carolina, Hernández Córdova, Karina, Delgado Quinteros, Edgar Fernando, Brito Quevedo, Luz Mery, Mendoza Oviedo, Juan Jose, Samanez Obeso, Angel, Paredes Espinoza, Patricia, de Guzman, Johann, Yu, Raisa, Cosoreanu, Vlad, Ionescu, Sebastian, Mironescu, Aurel, Vida, Lucian, Papa, Adrian, Verdeata, Roxana, Gavrila, Bogdan, Muntean, Liviu, Lukac, Marija, Stojanovic, Miona, Toplicic, Djordje, Slavkovic, Milan, Slavkovi, Andjelka, Zivanovic, Dragoljub, Kostic, Ana, Raicevic, Maja, Nkuliza, Delphine, Sidler, Daniel, Vos, Corné de, Merwe, Elmarie vd, Tasker, David, Khamag, Omar, Rengura, Cecilia, Siyotula, Thozama, Jooma, Uzair, Delft, Dirk von, Arnold, Marion, Mangray, Hansraj, Harilal, Shamaman, Madziba, Sanele, Wijekoon, Naveen, Gamage, Tharanga, Bright, Benedict Paul, Abdulrahman, Alaa, Mohammed, Ola Ahmed Abdulmjeed, Salah, Mohammed, Ajwa, Ahmad Elian Abu, Morjan, Mohammed, Batal, Mohammad Mohannad, Faks, Vivian, Mouti, Mohamad Bassel, Assi, Ahmadfateh, Al-Mouakeh, Ahmad, Tarabishi, Ahmad Sankari, Aljarad, Ziad, Alhamid, Aos, Khorana, Jiraporn, Poocharoen, Wannisa, Liukitithara, Sirima, Sriniworn, Anan, Nuntasunti, Wasun, Ngerncham, Monawat, Phannua, Ratiyaporn, Thaiwatcharamas, Kanokrat, Tanming, Patchareeporn, Sahnoun, Lassaad, Kchiche, Nahla, Abdelmoumen, Roua, Eroğlu, Egemen, Ozen, Mehmet Ali, Cömert, Hatice Sonay Yalçın, İmamoğlu, Mustafa, Sarıhan, Haluk, Kader, Şebnem, Mutlu, Mehmet, Aslan, Yakup, Beşir, Ahmet, Geze, Şükran, Çekiç, Bahanur, Yalcinkaya, Ali, Sönmez, Kaan, Karabulut, Ramazan, Türkyılmaz, Zafer, Şeref, Kıvanç, Altın, Merve, Aykut, Merve, Akan, M.Eren, Erdem, Melisa, Ergenekon, Ebru, Türkyılmaz, Canan, Keleş, Elif, Canözer, Ali, Yeniay, Aslı Öztürk, Eren, Elif, Cesur, İlknur Banlı, Özçelik, Zerrin, Kurt, Gökmen, Mert, Mustafa Kurthan, Kaya, Hatice, Çelik, Müge, Karakus, Suleyman Cuneyt, Erturk, Nazile, Suzen, Alev, Hakan, Nilay, Akova, Fatih, Pasaoglu, Mehmet, Eshkabilov, Shukurali, Yuldashev, Rustam Z., Abdunomonovich, Dekhkonboev Avazjon, Muslimovich, Aliev Makhmudjan, Patel, Azad, Kapihya, Chisengo, Ensar, Nicholas, Nataraja, Ramesh M, Sivasubramaniam, Mithila, Jones, Matthew, Teague, Warwick, Tanny, Sharman Tan, Thomas, Gordon, Roberts, Kiera, Venkatraman, Soundappan Sannappa, Till, Holger, Pigeolet, Manon, Dassonville, Martine, Shikha, Anas, Win, Win Sabai Phyu, Ahmad, Zahidah Adlynee Haji, Meloche-Dumas, Léamarie, Caouette-Laberge, Louise, St-Vil, Dickens, Aspirot, Ann, Piché, Nelson, Joharifard, Shahrzad, Safa, Nadia, Laberge, Jean-Martin, Emil, Sherif, Puligandla, Pramod, Shaw, Kenneth, Wissanji, Hussein, Duggan, Eileen, Guadagno, Elena, Puentes, Maria Consuelo, Leal, Paola Osses, Mendez Benavente, Carolina, Rygl, Michal, Trojanová, Barbora, Berková, Klára, Racková, Tereza, Planka, Ladislav, Škvařil, Jan, Štichhauer, Radek, Sabti, Shahad, Macdonald, Alex, Bouhadiba, Nordeen, Kufeji, Dorothy, Pardy, Caroline, Mccluney, Simon, Keshtgar, Alireza, Roberts, Rebecca, Rhodes, Hannah, Burns, Kate, Garrett-Cox, Robin, Ford, Kat, Cornwall, Hannah, Ravi, Krithi, Arthur, Felicity, Losty, Paul, Lander, Tony, Jester, Ingo, Arul, Suren, Gee, Oliver, Soccorso, Giampiero, Singh, Michael, Pachl, Max, Martin, Benjamin, Alzubair, Afnan, Kelay, Arun, Sutcliffe, Jonathan, Middleton, Thomas, Thomas, Amy Hughes, Kurian, Merina, Cameron, Fraser, Sivaraj, Jayaram, Thomas, Mark C, Rex, Dean, Jones, Ceri, Bradshaw, Kate, Bonnard, Arnaud, Delforge, Xavier, Duchesne, Camille, Gall, Caroline Le, Defert, Coralie, Laraqui Hossini, Samia, Guerin, Florent, Hery, Géraldine, Fouquet-Languillat, Virginie, Kohaut, Jules, Broch, Aline, Blanc, Thomas, Harper, Luke, Delefortrie, Thomas, Ballouhey, Quentin, Fourcade, Laurent, Grosos, Céline, Parmentier, Benoit, Levard, Guillaume, Grella, Maria Giovanna, Renaux Petel, Mariette, Grynberg, Lucie, Abbo, Olivier, Mouttalib, Sofia, Juricic, Mélodie, Scalabre, Aurelien, Haraux, Elodie, Rissmann, Anke, Krause, Hardy, Goebel, Peter, Patzer, Ludwig, Rolle, Udo, Schmedding, Andrea, Antunez-Mora, Alexandra, Tillig, Bernd, Bismarck, Sylvester von, Barbosa, Patricia Reis, Knorr, Christian, Stark, Domitille, Brunero, Marco, Avolio, Luigi, Manni, Francesco, Molinelli, Matilde, Guazzotti, Marinella, Raffaele, Alessandro, Romano, Piero Giovanni, Cavaiuolo, Silvia, Parigi, Gian Battista, Juhasz, Laszlo, Rieth, Anna, Strumila, Arunas, Dagilytė, Rūta, Liubsys, Arunas, Gurskas, Pranas, Malcius, Dalius, Mikneviciute, Agne, Vinskaite, Asta, Barauskas, Vidmantas, Vierboom, Liam, Hall, Timothy, Beasley, Spencer, Goddard, Lucy, Stringer, Mark, Weeratunga, Naveen, Adams, Stephen, Cama, Jitoko, Wong, Marilyn, Jayaratnam, Sridharan, Kukkady, Askar, Samarakkody, Udaya, Gerus, Sylwester, Patkowski, Dariusz, Wolny, Agnieszka, Koszutski, Tomasz, Tobor, Szymon, Osowicka, Marta, Czauderna, Piotr, Wyrzykowski, Dariusz, Garnier, Hanna, Anzelewicz, Stefan, Marta, Osowicka, Knurowska, Agata, Weiszewsk, Alicja, Grabowski, Andrzej, Korlacki, Wojciech, Pasierbek, Michal, Wolak, Przemyslaw, Piotrowska, Aneta, Roszkiewicz, Anna, Kalicińsk, Piotr, Trypens, Agata, Kowalewsk, Grzegorz, Sigalet, David, Alsaied, Amer, Ali, Mansour, Alsaggaf, Ameen, Ghallab, Alaa, Owiwi, Yazeed, Zeinelabdeen, Ali, Fayez, Mohamed, Atta, Ahmed, Zidan, Mazen, Radwan, Asaad saleh, Shalaby, Hanin, Abdelbaqi, Reem, Alattas, Khalid, Kano, Yar, Sindi, Omar, Alshehri, Abdullah, Altokhais, Tariq, Alturki, Fahad, Almosaibli, Mohammad, Krisanova, Dasha, Abbas, Wisam, Yang, Hee-Beom, Kim, Hyun-Young, Youn, Joong Kee, Chung, Jae Hee, Cho, Seok Hyeon, Hwang, In ji, Lee, Ju yeon, Song, Eung song, Arboleda, Jenny, Ruiz de Temiño Bravo, Mercedes, Siles Hinojosa, Alexander, García, Miriam, Casal Beloy, Isabel, Oliu San Miguel, Detlef, Molina Vazquez, Maria Elena, Alonso, Verónica, Sanchez, Alberto, Gomez, Oscar, Carrillo, Isabel, Wester, Tomas, Mesas Burgos, Carmen, Hagander, Lars, Salö, Martin, Omling, Erik, Rudolfson, Niclas, Granéli, Christina, Arnadóttir, Helena, Grottling, Emma, Abrahamsson, Kate, Gatzinsky, Vladimir, Dellenmark Blom, Michaela, Borbonet, Daniel, Puglia, Paul, Jimenez Morejon, Vinicio, Acuna, Gaston, Moraes, Mario, Chan, Jonathan, Brahmamdam, Pavan, Tom, Alan, Sherer, Karen, Gonzales, Brandy, Cunningham, Aaron, Krishnaswami, Sanjay, Baertschiger, Reto, Leech, Mary, Williams, Regan, Camp, Lauren, Gosain, Ankush, Mora, Maria, Lyttle, Bailey D., Chang, Jeremy, McColl Makepeace, Lydia, Fowler, Kathryn L, Mansfield, Sara, Hodgman, Erica, Amaechi, Chukwubinyelum, Beres, Alana, Pernik, Mark N., Dosselman, Luke J., Almasri, Murad, Jain, Sunil, Modi, Varun, Fernandez Ferrer, Marianelly, Coon, John, Gonzalez, Joann, Honhar, Medhavi, Ruzgar, Nensi, Coghill, Griffin, Ullrich, Sarah, Cheung, Maija, Løfberg, Katrine, Greenberg, Jodie, Davenport, Kate, Gadepalli, Samir, Fox, Sarah, Johnson, Stephanie, Pilkington, Mercedes, Hamilton, April, Lin, Nicole, Sola, Juan, Yao, Yang, Davis, Jenna Kylene, Langer, Monica, Vacek, Jonathan, Abdullah, Fizan, Khlevner, Julie, Middlesworth, William, Levitt, Marc, Ahmad, Hira, Siddiqui, Sabina M, Bowder, Alex, Derks, Terry, Amoabin, Afua Amoabin, Pinar, Brooke, Owusu-Sekyere, Frank, Saousen, Benmanseur, Naidoo, Rasika, Karamustafic, Azra, Oliveira, Danielle Paula de, Motter, Sarah Bueno, Andrade, Jerhy, Šafus, Antonín, Langley, Jason, Wilke, Alexandra, Deya, Corazone, Murtadi, Habib Mansour, Berzanskis, Mindaugas, Calistus, Nwachukwu, Ajiboye, Olalekan S., Felix, Michael, Olabisi, Osagie O, Erçin, Seçil, Muradi, Teymursha, Burks, Stephen S., Lerma, Sergio, Jacobson, Jillian, Calancea, Calin, Valerio-Vazquez, Rafael, Sikwete, Guigui, Sekyere, Owusu, Mbonisweni, Akhona, Syed, Shahnoor, Hyeon, Cho Seok, Pajouhandeh, Fatemeh, and Kunfah, Sheba Mary Pognaa

Abstract

Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality.

Published
2021
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16. Spontaneous rupture of the spleen secondary to amyloidosis.

Author

Báez-García Jde J, Martínez-Hernández Magro P, Iriarte-Gallego G, and Báez-Aviña JA

Subjects
Humans, Male, Middle Aged, Rupture, Spontaneous, Amyloidosis complications, Splenic Diseases complications, Splenic Rupture etiology
Abstract

Background: Rupture of the spleen has been classically associated with trauma. It sometimes is a spontaneous event or may be secondary to a pathological condition of the spleen or even in a healthy spleen. Systemic amyloidosis is characterized by the extracellular deposition of amyloid proteins in one or more organs. The spleen can be affected in 41% of patients. We undertook this study to present a case of spontaneous splenic rupture secondary to amyloid infiltration of the spleen, an uncommon condition in the literature., Clinical Case: We present the case of a 46-year-old male with abdominal pain, fever, abdominal distention and tachycardia. There were peritoneal signs during physical examination and leukocytosis was reported in the laboratory tests. The patient previously received analgesics and we suspected acute appendicitis modified by medications. It was decided to perform a laparotomy, finding hemoperitoneum as a consequence of spleen rupture. We performed splenectomy with a favorable patient outcome. Histopatological study reported amyloid infiltration of the spleen., Conclusions: In patients with abdominal pain and hypotension, we should suspect the possibility of a spontaneous splenic rupture, even without trauma or infection.

Published
2010

17. [Bouveret's syndrome; a case report].

Author

Báez-García JJ, Martínez-Hernández-Magro P, and Iriarte-Gállego G

Subjects
Aged, Female, Humans, Syndrome, Duodenal Obstruction diagnosis, Duodenal Obstruction surgery, Gallstones diagnosis, Gallstones surgery, Gastric Outlet Obstruction diagnosis, Gastric Outlet Obstruction surgery
Abstract

Objective: To present a rare case of duodenal obstruction caused by an impacted gallstone(Bouveret s syndrome) and discusses the best therapeutic option for its resolution., Background: Bouveret's syndrome is the less common presentation of a gallstone ileus. This syndrome is rare and predominates in elderly women; the main symptoms are nausea, vomiting, and epigastric pain, and sometimes hematoemesis, mimicking a pyloric stenosis. Diagnosis is made by endoscopy. Endoscopic lithotripsy must be the first-line treatment however surgery is indicated in case of failure or complication during the procedure. Morbidity and mortality rates are high., Case Report: We present a 75 years old, female patient, with history of diabetes mellitus and hypertension. With 15 days of nausea, vomiting,loss of appetite and abdominal pain, with secondary dehydration and bad general conditions. She was subjected to an endoscopy and a duodenal obstruction by a large gallstone was founded,the endoscopic attempts to extract the gallstone were unsuccessful and surgery was performed with a dudenotomy and two layer closure with good outcome. The patient was discharged on the 8th postoperative day., Conclusions: Bouveret's syndrome is a rare variety of a gallstone ileus and must be considered like differential diagnosis in cases of gastric outlet obstruction.

Published
2009

18. [Anal malignant melanoma. Case report and literature review].

Author

Martínez-Hernández-Magro P, Villanueva-Sáenz E, and Chávez-Colunga LB

Subjects
Aged, Aged, 80 and over, Diagnosis, Differential, Female, Humans, Male, Anus Neoplasms pathology, Melanoma pathology
Abstract

Objective: To present two cases of anorectal malignant melanoma as due to its non specific presentation and rarity they are often misdiagnosed like hemorrhoids., Background: Anal melanomas are rare tumors that constitute less than 1% of the malignant colorectal tumors and represent both a diagnostic and therapeutic challenge to physicians. They are generally pigmented but could be amelanotic in 29% of the cases and they are associated with poor prognosis, regardless of the surgical procedure used. Melanomas are often misdiagnosed by a lot of anorectal conditions and diagnosis must be suspected in patients with an anal mass., Case Report: We present two anorectal cases of malignant melanoma treated by wide local excision, the principal complain in both patients was the presence of an anal mass and bleeding. Both patients were treated by local excision since survival rates are comparable to those of patients treated by abdomino perineal resections (with a high morbility and mortality rates) and a better quality of life is achieved with control of the symptoms., Conclusions: Anal melanoma is a rare entity with a poor prognosis. The overall treatment goal should be to optimize the quality of life.

Published
2009

19. [Colonic duplication. A case report and literature review].

Author

Herrera Arias AA, Montaño Sandoval OC, and Martínez Hernández-Magro P

Subjects
Abdomen, Acute etiology, Adolescent, Female, Humans, Intestinal Obstruction etiology, Abdomen, Acute surgery, Colon abnormalities, Colon surgery, Intestinal Obstruction surgery
Abstract

Introduction: Colonic duplication is an uncommon congenital anomaly. Bowel obstruction, presence of an abdominal mass, and sometimes bleeding and perforation may be the clinical manifestations., Objective: To report a patient with colonic duplication who underwent to surgical treatment due to acute abdominal pain., Report of the Case: 17 year-old, female patient admitted to the emergency room due to acute abdominal pain and signs of intestinal obstruction, at her initial evaluation she was tachycardic, hyperthermic with 38 degrees C, dehydration, abdominal distention, acute abdominal pain, absent peristalsis and peritoneal signs. Laboratories with Hb 14.2 g/dL, leucocytosis of 16,000 mm3, plain abdominal films showed dilation of intestinal loops and air-fluid levels. A laparotomy for intestinal obstruction was performed; operative findings were a tubular colonic duplication that demands a complete resection of the duplicated segment., Conclusion: Colonic duplication is a rare congenital anomaly, the onset of the symptoms can occur during infancy or early childhood. It must be consider as differential diagnoses in patients with intestinal obstruction and palpable abdominal mass in this rank of ages.

Published
2008

20. [Double stapler technique in colorectal surgery].

Author

Villanueva-Sáenz E, Sierra-Montenegro E, Rojas-Illanes M, Peña-Ruiz Esparza JP, Martínez Hernández-Magro P, and Bolaños-Badillo LE

Subjects
Adult, Aged, Aged, 80 and over, Anastomosis, Surgical methods, Colitis, Ulcerative surgery, Colorectal Neoplasms surgery, Diverticulosis, Colonic surgery, Equipment Design, Female, Humans, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Surgical Staplers, Treatment Outcome, Colonic Diseases surgery, Rectal Diseases surgery, Surgical Stapling methods
Abstract

Background: Colorectal surgery has evolved significantly during the last 35 years. The circular stapler and the double stapler techniques have favored the development of very low rectal anastomoses with reduction in anastomotic leakage. The objective of this study is to evaluate the functional results and complication rate of this surgical technique in the Department of Colorectal Surgery at the Hospital de Especialidades, Centro Medico Nacional Siglo XXI and at the Hospital Angeles del Pedregal, both located in Mexico City., Methods: Clinical records of patients who underwent surgery from May 1995 to December 2005 using the double stapler technique and performed by the authors were reviewed., Results: The study included 142 patients, 55 of whom had rectosigmoid cancer resections. Average age was 60.1 years (male predominance 52.05%). The circular stapler most frequently used was CDH 33 (Johnson & Johnson). Average distance between the anal margin and the anastomoses for extended low anastomoses was 3.21 cm (low 7.8 cm and high 13.7 cm), and the rate of anastomoses leak was 3.52%., Conclusions: Double stapler technique used to treat rectosigmoid pathology is safe, secure and assures intestinal continuity in low anterior as well as extended low anterior resections with primary anastomoses. In those patients with associated risk factors and low extended low anterior resection with primary anastomoses, we recommend performing a protective stoma (ileostomy).

Published
2008

21. [Quality of life after restorative proctocolectomy with ileo-anal J pouch in patients with ulcerative colitis].

Author

Sierra-Montenegro E, Fernández-Rivero JM, Villanueva-Sáenz E, Peña-Ruiz Esparza JP, Martínez-Hernández Magro P, and Solo-Quirino R

Subjects
Adult, Anal Canal surgery, Cross-Sectional Studies, Female, Humans, Ileum surgery, Male, Middle Aged, Retrospective Studies, Colitis, Ulcerative surgery, Proctocolectomy, Restorative, Quality of Life
Abstract

Background: Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most common treatment in patients with ulcerative colitis. This procedure removes the entire colon, conserving the sphincteric complex and, therefore, preserving continence. The most important goal of this surgery is to improve quality of life., Methods: We reviewed the files of patients who underwent restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis from January 1995 to December 2004 . We administered questionnaire SF-36 to evaluate quality of life. We used an observational, retrospective, and transversal method., Results: Twenty "J" pouch procedures were done, of which files of 14 patients were reviewed. As far as quality of life, we were able to interview only eight patients and the average was as follows: physical function 75, physical status 50, corporal pain 51, general health 77, vitality 47.5, social function 62.50, emotional status 83 and mental health 74., Discussion: Previous reports exist showing that proctocolectomy is a safe and effective procedure for patients with ulcerative colitis and where ileostomy is accompanied by one definitive, independent continent or pouch., Conclusions: The presence of stoma and fecal incontinence are factors that contribute to deterioration of quality of life after proctocolectomy; thus, both should be avoided. Of the patients who we interviewed, 87.5% consider that their health status has improved during 1 year.

Published
2007

23. [Anal incontinence caused by an obstetric trauma. Experience with the technique of overlapping sphincteroplasty].

Author

Martínez Hernández Magro P, Godínez Guerrero MA, Rivas Larrauri E, Herrera Huterer D, and Barrón Vega R

Subjects
Adult, Anal Canal surgery, Digestive System Surgical Procedures methods, Fecal Incontinence diagnosis, Fecal Incontinence surgery, Female, Humans, Middle Aged, Obstetric Labor Complications diagnosis, Pregnancy, Retrospective Studies, Treatment Outcome, Anal Canal injuries, Delivery, Obstetric adverse effects, Fecal Incontinence etiology, Obstetric Labor Complications surgery
Abstract

Introduction: Anal incontinence (IA) could be of idiopathic, congenital, neurological origin, or secondary to trauma. Obstetric trauma is the most common cause of the traumatic anal incontinence., Objective: To analyze results of a group of patients with anal incontinence secondary to obstetric trauma, with overlapping sphincteroplasty., Patients and Methods: All patients with anal incontinence secondary to obstetric trauma without neurological damage, between January 2002 to January 2006 were studied; all of them underwent overlapping sphincteroplasty. We evaluated improvement in incontinence score according Jorge and Wexner incontinence scale, pre and postoperatively as well as morbi-mortality rates., Results: 16 patients, most of them with total anal incontinence, with preoperative values between 16 to 20 points at the Jorge and Wexner scale; 14 patients (87.5%) referred improvement in their values with 4 to 0 points postoperatively, two patients did not refer significant improvement, both of them with defects in both sphincters and loss of the 50% of the entire sphincteric complex. They were sent to bio-feedback therapy. There was not mortality. Seven patients (43.7%) had skin dehiscence., Conclusions: Overlapping sphincteroplasty is an accurately technique for repair obstetric trauma injuries of the anal sphincter, with a success rate of 70 to 80%, and a low morbidity rate.

Published
2006

24. [Surgical treatment of complete rectal prolapse. Experience at a colon and rectal surgery service].

Author

Martínez Hernández-Magro P, Villanueva Sáenz E, and Sandoval Munro RD

Subjects
Adult, Aged, Aged, 80 and over, Colorectal Surgery, Digestive System Surgical Procedures methods, Female, Hospital Units, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Treatment Outcome, Rectal Prolapse surgery
Abstract

Background: Rectal prolapse is as ancient humanity. Treatment must be surgical in adult patients. There is no gold standard procedure to date; thus, this has given rise to controversy., Objective: One objective was to analyze our results, complications, mortality, and recurrence in a Colorectal Surgery Service for surgical treatment of complete rectal prolapse., Patients and Methods: We reviewed records of all patients treated surgically with rectal prolapse at our Service from March 1995 to March 2001., Results: 31 patients; 22 were female and nine male with age range of 24 to 89 years. Evolution time was 6 months to 40 years; 11 patients had preoperative incontinence. We carried our four procedures, abdominal procedure hospital stay was 4 to 7 days; we had 18% long-term complications with no mortality or recurrence. Hospital stay in perineal procedures was 1 to 2 days with one procedure associated with death due to AV blockade, with 14% recurrence for helicoidal suture procedure, and no complications. Altemeier procedure recurred at 1 month of surgery. Continence score of Miller improve postoperatively., Conclusions: Abdominal procedures have less recurrence than perineal procedures; abdominal procedures must be considered in young patients with low risk, and perineal procedures in older patients with high risk, that are coantraindications for a major surgical procedure.

Published
2003

25. Colonic tuberculosis.

Author

Villanueva Sáenz E, Martínez Hernández Magro P, Fernando Alvarez-Tostado Fernández J, and Valdés Ovalle M

Subjects
Abdominal Pain etiology, Adult, Antitubercular Agents therapeutic use, Diagnosis, Differential, Female, Humans, Male, Risk Factors, Weight Loss, Colonic Diseases diagnosis, Colonic Diseases drug therapy, Colonic Diseases epidemiology, Tuberculosis, Gastrointestinal diagnosis, Tuberculosis, Gastrointestinal drug therapy, Tuberculosis, Gastrointestinal epidemiology
Abstract

Tubercle bacillus was discovered in 1882 by Robert Koch. With the introduction of chemotherapy for tuberculosis in the 1940s the incidence of this entity decreased. The incidence of the tuberculosis of the colon began to increase at the 1980s with the rise in numbers of patients considered as high risk for this entity, such as HIV-infected individuals, patients with chronic renal disease, and immunosuppressed patients with prolonged steroid therapy. We report on two patients with history of chronic abdominal pain and weight loss with a palpable mass in the right lower quadrant. In one patient chest radiography revealed a miliary reticulonodular pattern. In both, abdominal CT scan showed retroperitoneal lymphadenopathy and colonic wall thickness. Colonoscopic examination showed ulcerative lesions and ileocecal valve disruption. Microscopic examination of intestinal content showed evidenced M. tuberculosis. Tuberculosis of the colon should be suspected in patients suffering from chronic abdominal pain and weight loss.

Published
2002
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26. [Surgical treatment of unspecific chronic ulcerative colitis. A 5-year experience].

Author

Martínez-Hernández-Magro P, Villanueva-Sáenz E, Alvarez-Tostado-Fernández F, and Gutiérrez-Roa A

Subjects
Adult, Aged, Anastomosis, Surgical, Colonic Pouches, Female, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Treatment Outcome, Colectomy methods, Colitis, Ulcerative surgery, Colon surgery
Abstract

Background: Treatment of ulcerative colitis depends on clinical stage of disease and have precise surgical indications. The aim of this work was to review surgical indications and present data related to our experience., Material and Methods: Retrospective, descriptive, and transversal study. We reviewed records of all patients who underwent a surgical procedure for ulcerative colitis at our service from March 1996 to March 2001., Results: Twenty two patients, 13 males and nine females, ages range 21 to 72 years. Main indication for surgery was no response to medical treatment (50%). Surgical procedures was subtotal colectomy with ileostomy in one patient, intersphincteric proctocolectomy with ileostomy in four intersphincteric proctectomy with ileostomy in three ileorectalanastomosis in three proctocolectomy with ileoanal "J" pouch in six and proctectomy with ileoanal J pouch in five. We had the following complications: oral candidiasis; phlebitis; eventration; pouchitis, and anal fissure in one patient, respectively, pouch-skin fistula in two patients (9%), and retrograde ejaculation in one of these. Follow-up was for 5 years., Conclusions: Surgical indications for ulcerative colitis are precise. We recommend early surgical evaluation. Ileoanal pouch is now considered the gold standard for surgical procedure because it eliminates disease, neoplasm development, and permanent extra-colonic manifestations, and restores continence.

Published
2002

27. [Ischemic colitis in patients submitted to aortic replacement surgery. Risk factors].

Author

Alvarez-Tostado-Fernández F, Martínez-Hernández-Magro P, and Villanueva-Sáenz E

Subjects
Acidosis etiology, Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal complications, Colitis, Ischemic diagnosis, Colitis, Ischemic therapy, Colonoscopy, Female, Humans, Logistic Models, Male, Reoperation, Retrospective Studies, Risk Factors, Treatment Outcome, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects, Colitis, Ischemic etiology, Postoperative Complications
Abstract

Unlabelled: Ischemic colitis (IC) is an important clinical problem, and may present after aortic surgical procedures. The aim of this work was to establish risk factors for IC presentation in aortic surgical replacement patients., Material and Methods: A retrospective study of patients with aortic surgical replacement in a 3-year period was carried out. Patients were divided into two groups: patients without IC and patients with IC, the later group subdivided into patients with gangrenous ischemic colitis and without gangrenous ischemic colitis. Multiple logistic regressions was used to obtain the variables for possible risk factor for IC., Results: We included 101 patients in the study; ischemic colitis was present in 16.8% of all cases, with 47.1% of gangrenous type. Metabolic acidosis was the most frequent alteration. Diagnosis was made by endoscopy in 94.1%. Mortality in IC group was 18.2% with an increase in the gangrenous group to 62.5%. Identified risk factors were disrupted aneurysm, previous colonic surgery, emergency surgery, and hemodynamic instability., Conclusions: Ischemic colitis is most frequent in emergency surgery for disrupted aneurysm in the hemodynamically unstable patient with retroperitoneal hematoma. We must entertain a high suspicion index for IC in all patients with aortic surgical procedures for early detection and adequate treatment.

Published
2002

28. [Perianal leukemic infiltration. Case report].

Author

Martínez-Hernández-Magro P, Villanueva-Sáenz E, and Ramírez-Aceves R

Subjects
Adult, Female, Humans, Leukemia, Myeloid, Acute therapy, Anal Canal pathology, Leukemia, Myeloid, Acute pathology, Leukemic Infiltration therapy, Skin pathology
Abstract

Background: Leukemic infiltration of perianal skin (leukemia cutis) is quite uncommon, and may consist of no diffuse infiltration, erythema, ulceration, fistula, and abscess. Diagnosis may be established by biopsy and adequate hematologic studies. Treatment must be conservative in patients with poorly controlled disease (sitz baths, antibiotics, radiotherapy), and surgical in patients with risk of fulminant sepsis and death., Objective: To report a case of leukemic perianal infiltration with atypical ulcerated lesion., Case Report: Female patient, 21 years of age with diagnosis of AML M7, began with perianal pain posterior to evacuation associated with bleeding; at perianal examination we found anterior atypical ulcerated lesion. We carried out a biopsy under suspicion of leukemic infiltration corroborated by histopathology. The patient received conservative treatment., Conclusions: We must suspect leukemic infiltration in patients with anal symptoms and effect close surveillance. Prognosis depends on control of hematologic disease.

Published
2002

29. [Colonic primary lymphoma].

Author

Villanueva-Sáenz E, Alvarez-Tostado Fernández JF, Martínez Hernández-Magro P, Valdés-Ovalle M, and Peña Ruiz-Esparza JP

Subjects
Adult, Aged, Female, Humans, Male, Colonic Neoplasms therapy, Lymphoma therapy
Abstract

Unlabelled: Primary colon lymphomas (PCL) are very rare tumors of the gastrointestinal tract, and represent 0.2-0.5% of all colon primary tumors. They appear principally PCL in adult population. Almost all are non-Hodgkin's lymphomas; first however, one must discard lymph node origin. The most frequent sites of presentation are the cecum and rectum. Treatment of choice is surgical, plus adjuvant chemotherapy. Radiotherapy is reserved for specific cases., Objective: To inform on two cases of PCL., Method: Review two of cases of cecum lymphomas and their treatment., Results: We inform the cases of two patients with the diagnosis of cecum lymphoma. The main patient complaints were abdominal pain, palpable mass, and hemorrhage. Both patients were treated with right extended hemicolectomy and ileum-transverse anastomosis. The outcome was unremarkable. Both patients received chemotherapy and remain free of disease at 1.5 and 5 years of follow-up., Conclusions: Primary colon lymphomas are very uncommon gastrointestinal tumors, with cecum localization as one of the most frequent sites of presentation in the colon. Treatment of choice must be surgical, with chemotherapy as an adjuvant therapy to improve survival.

Published
2002

30. [Toxic megacolon secondary to pseudomembranous colitis].

Author

Villanueva-Sáenz E, Herrera JT, Martínez-Hernández Magro P, Ruiz-Esparza JP, Parrado-Montaño JW, and Mejía C

Subjects
Aged, Humans, Male, Enterocolitis, Pseudomembranous complications, Megacolon, Toxic etiology
Abstract

Background: Toxic megacolon is a rare complication of pseudomembranous colitis., Objective: The aim of this paper is to present a rare case of toxic megacolon secondary to pseudomembranous colitis., Methods: The chart of a 75-year-old male, who developed a toxic megacolon secondary to pseudomembranous colitis no was reviewed., Results: The clinical features and outcome of a 75-year-old male with pseudomembranous colitis are depicted. The main symptoms were no ever, abdominal distention, bloody and diarrhea; the man suddenly developed a toxic megacolon and taken was to surgery. Total colectomy with proximal rectal closure was performed. The patient died within 24 hours of the abdominal procedure., Conclusions: Toxic megacolon is a rare complication of pseudomembranous colitis. Its presence should be suspected when these patients develop no colonic dilatation with associated systemic toxicity. Aggressive surgical intervention is indicated.

Published
2001

31. [Transmesenteric intestinal plication for intestinal occlusion secondary to disseminated adhesions. A 12-year experience].

Author

Martínez-Hernández-Magro P, Martínez-Ordaz JL, and Blanco-Benavides R

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Intestinal Diseases complications, Intestinal Obstruction etiology, Male, Mesentery, Middle Aged, Time Factors, Tissue Adhesions complications, Digestive System Surgical Procedures methods, Intestinal Obstruction surgery
Abstract

Objective: To report the experience with intestinal plication in patients with adhesive intestinal obstruction that was followed up to 12 years., Background: To diminish the high recurrence rate of adhesive intestinal obstruction, there are surgical techniques of intestinal plication. In 1977 Blanco modified a pre-existing transmesenteric technique that is the used in our institution., Method: We studied the medical records of 32 patients who underwent intestinal plication using the transmesenteric technique. The postoperative evaluation was based in recurrence and mortality., Results: There were 32 patients, 56% women and 44% men, with a mean age of 50 years. All patients had a history of intraabdominal surgical procedures. The postoperative evaluation was satisfactory. The success rate was over 90%. The recurrence rate was 9.3% and we had no mortality. The mean follow-up was 3.5 years (median 3 [range 1-12] years). There were no significant differences between this technique and the Noble and Childs-Phillips plication techniques., Conclusions: This technique of intestinal plication is useful in the surgical management of patients with adhesive intestinal obstruction.

Published
2001

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