Ménétrier disease is a rare condition of an unknown origin, with a wide spectrum of clinical signs and symptoms at presentation. Diagnosis is made through the combination of clinical, analytical, endoscopic and histological data. Surgery is the classical treatment. However, new medical approaches have emerged.
Functional dyspepsia impacts on quality of life. Due to its multifactorial etiology its characterization proves difficult, especially in populations at risk such as medical students.
Objetives: To determine if behavioral and harmful habits of medical students from eight universities of Peru were associated to functional dyspepsia.
Methods: Multicentric, cross-sectional study. A self-administered questionnaire was taken among students enrolled in eight medical faculties in Peru. Functional dyspepsia was measured using a validated test; diet characteristics, alcohol, tobacco, coffee or energy drinks consumption were considered behavioral habits. Furthermore, others from the social and educational sphere were measured. Bivariate and multivariate statistical analyses were made.
Results: From a total of 1.923 students, the median of the ages was 20, 55% were women and 24% suffered from functional dyspepsia. Factors which diminished the frequency of functional dyspepsia were masculine gender (aPR:0,75; 95%CI:0.64-0.87; p < 0,001), hours spent studying (aPR:0,97; 95%CI:0,96-0,99; p < 0,001) and eating following a fixed schedule (aPR:0,80; 95%CI:0,67- 0,95; p = 0,013); however, having failed a course increases the frequency of functional dyspepsia (aPR:1.24; 95%CI:1.13-1.37; p < 0,001)adjusted for age, as well as difficulties to fall asleep and depression.
Conclusion: Many medical students suffered from functional dyspepsia, this being related to several behavioral variables; therefore further studies as well as educational institutions’ intervention is required, due to the short and long term problems that may arise from this situation.
Obesity is an epidemic with important health repercussions in addition to high treatment-related costs. Between 2006 and 2007 the WHO developed new assessment tools, which aren't being globally used. In fact, there is no unified problem management across the hemisphere.
Objectives: To update obesity epidemiology, to promote application of WHO’s standards, to review new findings on physiopathology (i.e., fatty tissue as endocrine organ, intestinal microbiota), to update epidemiological information, and to provide management guidelines that can be integrated in clinical care.
Methods: LAPSGHAN called up its members to collaborate in preparing this review article under the direction of an editor/coordinator, who selected the contents and literature with the best evidencetogether with the members. Each member prepared a separate document for each content. The chosen contents were later collated, unified, and edited. Results. This documents highlights the following: 1) Although extreme obesity is increasing in the US, overweight and obesity prevalence has stabilized, while in other countries it is alarmingly increasing; 2) New information regarding role of fatty tissue as endocrine organ and self-regulator of obesity; 3) The promising role of microbiota; and 4) Guidelines for children handling during consultation and follow-up.
Conclusions: There is no widespread implementation of standards and guidelines from the World Health Organization (WHO). There is no agreement as to whether z-scores or percentiles should be used, especially regarding children under 2 due to their changing body complexion. The most accepted tool to assess overweight, obesity and severe obesity is the Body Mass Index (BMI). This document provides recommendations on how to approach clinical care with affected children.
GERD is a highly prevalent disease in our country. It has a deep impact in patient´s quality of life, representing extremely high costs regarding health. The correct understanding of its pathophysiology is crucial for the rational use of diagnoses methods and the implementation of appropriate treatment adjusted to each individual case. In this review we evaluate this disorder based on the best available evidence, focusing in pathophysiological mechanisms, its epidemiology, modern diagnosis methods and current management standards.
Sacral neuromodulation involves electrical stimulation of afferent nerve roots to restore the balance between inhibitory and excitatory reflexes who improve the functional activity of the pelvic floor. With benefits in patients with fecal incontinence, constipation and chronic anorectal pain. Objective. The aim of this study is present the results obtained with sacral neuromodulation for the treatment of patients with fecal incontinence, severe and intractable chronic constipation and chronic anorectal pain. Patients and methods. 33 patients had indication for transitory electrical sacral stimulation, 25 patients performed transitory electrical stimulation for fecal incontinence, 5 with refractary constipation and 3 with chronic anorectal pain. In cases of fecal incontinence, the patients performed previous anorectal manometry and ultrasonography examination of anal sphincters. When the constipation is the indication, we performed stimulation in patients with severe and refractary constipation like step before total colectomy. In cases of chronic anorectal pain, the electrical transitory test was performed according to our treatment algorithm for management of functional anorectal pain. In all cases, if the patients had satisfactory results after 2 weeks period the definitive implant was placed. Results. Mean follow-up was 69 months (range 6-130). Definitve implant was placed for treatment of fecal incontinence in 23 patients with a decrease in fecal incontinence scores in 98%, with an average success rate of 66% (range: 45-92). In cases of constipation, 3 definitive implants were placed, the mean follow-up was 77 months (range: 51-96) with a success rate between 50%-80% as measured by bowel frequency. We performed definitive electrical stimulation in 3 patients wit chronic and intractable anorectal pain. Response rates as measured by visual analog scale were between 40%-70%. Conclusions. Sacral neuromodulation is an area in constant growth, with more indications. The success depends on the correct indication and the patients need to be treated with other therapeutic options before sacral neuromodulation.
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