Miguel Puga-Tejada

Background: Saccadic eye movements (SEMs) are rapid, precise movements that reorient the visual fovea toward an object of interest. In clinical practice, assessing SEMs can help in differentiating and monitoring various neurologic, otoneurologic, and psychiatric conditions. Deviations from adequate saccadic patterns offer critical diagnostic information, enabling clinicians to more accurately identify related conditions such as schizophrenia, attention deficit hyperactivity disorder, Alzheimer’s disease, and cognitive impairment in vestibular migraine, among others. Purpose: Establish normative data for prosaccades (PSs) and antisaccades (ASs) in healthy adolescents aged 12‐17 years. Research Design: A cross-sectional, single-center study conducted between June and December 2023. Study Sample: Data were reported on 138 healthy participants aged 12 to 17 years with no history of head trauma, neurologic, vestibular, behavioral, or psychiatric disorders, and use of medications affecting SEMs. Results: This study included 138 participants (mean age, 14.5 years; 44.2 percent female). A mean accuracy, latency, velocity, and directional error (DE) of 91.5 percent, 211 milliseconds (ms), 249.5 degrees per second (°/s), and 0.8 percent in PSs and 117.0 percent, 304.7 ms, 249.8°/s, and 11.8 percent for ASs were obtained, respectively. Significant reductions were found in horizontal random saccade velocity (p = 0.027), PS velocity (p = 0.001), AS latency (p < 0.001), and DE (p < 0.001) from younger to older adolescents. With age maturation, ASs’ latency and DE showed a significant reduction. Compared with females, male participants have lower AS latencies (p < 0.041). Younger males (Conclusions: This study established normative data for PSs and ASs for individuals aged 12‐17 years using commercially available equipment. The findings indicate age-related variations, particularly in AS latency and DE. Clinical Relevance Statement: The normative values obtained in this study could assist clinicians in the detection of cognitive control impairment or oculomotor dysfunction, and support complementary diagnostic tools in differentiating neurologic, vestibular, behavioral, or psychiatric disorders affecting adolescents.

Introducción. La información sobre morbimortalidad tras una gastrectomía subtotal o total es limitada en países en vías de desarrollo, especialmente ante el cambio epidemiológico del cáncer gástrico. Objetivo. Identificar factores asociados a morbimortalidad en pacientes con cáncer gástrico operados con intención curativa en un centro oncológico de Ecuador. Materiales y métodos. Estudio de cohorte histórica realizado en el Instituto Oncológico Nacional “Dr. Juan Tanca Marengo” (Guayaquil, 2019-2021). Se incluyeron adenocarcinomas gástricos operados con intención curativa. Se evaluaron eventos adversos y mortalidad (30, 90 días y global). Se estimaron factores asociados mediante regresión logística. Resultados. Se incluyeron 111 pacientes (87 gastrectomía subtotal, 24 total). Hubo ≥ 1 evento adverso en 15,4% (subtotal) y 17,9% (total). La mortalidad a 30, 90 días y global tras la gastrectomía subtotal fue, respectivamente, del 1,1%, 2,3% y 34,5%; tras la total fue de 0%, 4,2% y 54,2%, respectivamente. La presencia de eventos adversos se asoció con tumor Bormann III/IV (OR 9.6; IC95% 1,8 – 79,7; p = 0,0175) y una mayor estancia hospitalaria (OR 2,3; IC95% 1,4 – 5.1; p < 0,001). La mortalidad se asoció con Bormann III/IV (p = 0,0038) y dehiscencia gastro-duodenal (p = 0,0383). Conclusión. Las tasas de morbimortalidad a 90 días fueron menores a lo reportado en otras series. Bormann III/IV y dehiscencia gastroduodenal fueron factores asociados a mayor mortalidad.

Introducción. Es probable que, al determinar la prevalencia de gastritis atrófica crónica y metaplasia intestinal a partir de muestras procedentes de hospitales de tercer nivel, se sobreestime su frecuencia. Objetivo. Estimar la frecuencia de lesiones histológicas premalignas del estómago en un hospital de segundo nivel. Materiales y métodos. Estudio observacional, retrospectivo, descriptivo, transversal, epidemiológico. Se llevó a cabo en pacientes quienes ya se habían realizado una videoendoscopía digestiva altadiagnóstica independientemente del motivo clínico. Se excluyeron a pacientes con hemorragia digestiva, tumores o sin biopsia. Resultados. Se recuperaron 4454 casos, de los cuales 115 (2,6%, IC 2,2 - 3,1) tenían gastritis atrófica crónica. En comparación a la gastritis no atrófica, la presencia de gastritis atrófica crónica fue más frecuente en adultos mayores (43,5% vs. 24,9%; p < 001) y con síntomas de dispepsia (35,7% vs. 19,9%; p < 0,001), y menos frecuente en poblaciones económicamente activas (47,8% vs. 64,9%; p < 0,001). En los pacientes con gastritis atrófica crónica en comparación con los pacientes con gastritis no atrófica presentó Helicobacter pylori positivo (47,8% vs. 25,6%; p < 0,001). La infección por Helicobacter pylori incrementó casi tres veces el riesgo de contraer gastritis atrófica crónica (Odds Ratio 2,65; p < 0,001). Conclusión. En un hospital de segundo nivel, la prevalencia de lesiones histológicas premalignas es considerablemente menor a la reportada por estudios locales realizados en hospitales de tercer nivel. La presencia de gastritis atrófica crónica se asoció con edad avanzada, indicación de videoendoscopía digestiva alta por dispepsia e infección por Helicobacter pylori; mientras que la indicación por regurgitación se asoció a su ausencia.

Approximately 95% of patients with chronic hepatitis C achieve viral eradication through direct-acting antiviral (DAA) treatment. Ensuing clinical benefits include halting liver fibrosis, thereby reducing the need for liver transplantation, and decreasing both liver-related and overall mortality. It is well established that, although ameliorated, the risk of developing hepatocellular carcinoma (HCC) persists, particularly among patients with pre-treatment advanced fibrosis/cirrhosis. Current guidelines recommend indefinite HCC surveillance in these patients. However, a recent Markov model evaluation shows that HCC surveillance is cost-effective only for patients with cirrhosis but not so for those with F3 fibrosis, a finding which points out the need to better define the risk of HCC in hepatitis C patients after cure and further characterize pre- and post-treatment factors that might affect the incidence of HCC in this setting. We reviewed the literature analyzing this aspect. Here we summarize the main findings: male gender and older age are independent predictors of increased risk of post-cure HCC development. Moreover, non-invasive tests for hepatic fibrosis, namely FIB4, APRI, and liver stiffness, measured before and after treatment and their post-therapy change, contribute to better stratifying the risk of HCC occurrence. Furthermore, low serum albumin, as well as an AFP above 7 ng/mL prior to and after DAA therapy, also constitute independent predictors of HCC development. Considering these findings, we propose to classify patients with HCV viral eradication and advanced fibrosis/cirrhosis into groups of low, medium, or high risk of HCC and to adopt adequate surveillance strategies for each group, including protocols for abbreviated magnetic resonance imaging (MRI) for those at the highest risk.

Background and Objectives: Chronic liver inflammation leads to fibrosis and cirrhosis. To avoid portal hypertension-related complications, fibrosis' early detection is imperative. Biopsy remains the gold standard, but magnetic resonance elastography (MRE) and EUS-guided elastography are noninvasive procedures currently used for liver stiffness measurement (LSM). Two-dimensional EUS-guided shear-wave elastography (EUS-SWE) represents a more-every-day used technique. The aim of this study is to correlate LSM determined by vibration-controlled transient elastography (VCTE) and EUS-SWE and determine the measurements' accuracy in diagnosing cirrhosis. Methods: A single-center, nested case-control study was performed between March 2020 and November 2021. Patients were classified into 2 study groups: the cirrhosis group and the control group. Patients from both groups underwent VCTE and EUS-SWE for LSM. A P value < 0.05 was considered statistically significant. Results: Of the 59 participants included (mean age 63.5 years; 71.1% female), 29 had cirrhosis (49.15%) and 30 were controls (50.84%). In cirrhosis patients, liver fibrosis (F) was staged as F3–4 by VCTE in 82.8%, with a median LSM of 17.8 kPa; through EUS-SWE, 27 kPa in the right hepatic lobe (RHL) and 25 kPa in the left hepatic lobe (LHL). Controls fibrosis was staged as F0–2 by VCTE in 30/30 (100%), with a median LSM of 4.6 kPa (P < 0.001); through EUS-SWE, 5.6 kPa in the RHL (P < 0.001) and 6.5 kPa in the LHL (P < 0.001). The observed agreement was 91.5% for VCTE, 93.2% for RHL-EUS-SWE, and 96.6% for LHL-EUS-SWE. The AUROCs for EUS-SWE and VCTE were over 0.95. Conclusions: VCTE and EUS-SWE are comparable techniques for diagnosing cirrhosis; however, EUS-SWE had a higher agreement than VCTE, especially in LHL assessment.

Background and Aims: Achieving histological remission is a desirable emerging treatment target in ulcerative colitis (UC), yet its assessment is challenging due to high inter- and intraobserver variability, reliance on experts, and lack of standardization. Artificial intelligence (AI) holds promise in addressing these issues. This systematic review, meta-analysis, and meta-regression evaluated the AI’s performance in assessing histological remission and compared it with that of pathologists. Methods: We searched Medline/PubMed and Scopus databases from inception to September 2024. We included studies on AI models assessing histological activity in UC, with or without comparison to pathologists. Pooled performance metrics were calculated: sensitivity, specificity, positive and negative predictive value (PPV and NPV), observed agreement, and F1 score. A pairwise meta-analysis compared AI and pathologists, while sub-meta-analysis and meta-regression evaluated heterogeneity and factors influencing AI performance. Results: Twelve studies met the inclusion criteria. AI models exhibited strong performance with a pooled sensitivity of 0.84 (95% CI, 0.80–0.88), specificity 0.87 (0.84–0.91), PPV 0.90 (0.87–0.92), NPV 0.80 (0.71–0.88), observed agreement 0.85 (0.82–0.89), and F1 score 0.85 (0.82–0.89). AI models demonstrated no significant differences with pathologists for specificity, observed agreement, and F1 score, while they were outperformed by pathologists for sensitivity and NPV. AI models for the adult population were linked to reduced heterogeneity and enhanced AI performance at meta-regression. Conclusions: AI shows significant potential for assessing histological remission in UC and performs comparably to pathologists. Future research should focus on standardized, large-scale studies to minimize heterogeneity and support widespread AI implementation in clinical practice.

Antibiotic overuse and the resulting antimicrobial resistance pose significant global public health challenges, providing an avenue for opportunistic pathogens like Acinetobacter baumannii to thrive. This study will report the trends of Acinetobacter baumannii antimicrobial resistance patterns at the Hospital Teodoro Maldonado Carbo, Ecuador. An observational, analytical, longitudinal, and prospective study was conducted involving patients diagnosed with hospital-acquired infections. Antimicrobial susceptibility testing was performed, followed by molecular analysis of carbapenemase genes in Acinetobacter baumannii isolates. We included 180 patients aged from 16 to 93 years. The hospital mortality rate was 63/180 (35%). Invasive mechanical ventilation (IMV) was indicated in 91/180 patients (50.4%). The overall survival (OS) rate in patients on IMV was 49.5% (45/91), with a median survival of 65 days. The OS rate in patients not on IMV was 80.9% (72/89), with a median survival of 106 days (HR 2.094; 95% CI 1.174–3.737; p = 0.012). From multivariate analysis, we conclude that ventilator-associated pneumonia is the most related factor to OS.

INTRODUCTION: Cholecystectomy (CCY) is the gold standard treatment of acute cholecystitis (AC). Nonsurgical management of AC includes percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). This study aims to compare outcomes of patients who undergo CCY after having received EUS-GBD vs PT-GBD. METHODS: A multicenter international study was conducted in patients with AC who underwent EUS-GBD or PT-GBD, followed by an attempted CCY, between January 2018 and October 2021. Demographics, clinical characteristics, procedural details, postprocedure outcomes, and surgical details and outcomes were compared. RESULTS: One hundred thirty-nine patients were included: EUS-GBD in 46 patients (27% male, mean age 74 years) and PT-GBD in 93 patients (50% male, mean age 72 years). Surgical technical success was not significantly different between the 2 groups. In the EUS-GBD group, there was decreased operative time (84.2 vs 165.4 minutes, P < 0.00001), time to symptom resolution (4.2 vs 6.3 days, P = 0.005), and length of stay (5.4 vs 12.3 days, P = 0.001) compared with the PT-GBD group. There was no difference in the rate of conversion from laparoscopic to open CCY: 5 of 46 (11%) in the EUS-GBD arm and 18 of 93 (19%) in the PT-GBD group (P value 0.2324). DISCUSSION: Patients who received EUS-GBD had a significantly shorter interval between gallbladder drainage and CCY, shorter surgical procedure times, and shorter length of stay for the CCY compared with those who received PT-GBD. EUS-GBD should be considered an acceptable modality for gallbladder drainage and should not preclude patients from eventual CCY.

Aims To assess the anterograde's drainage clinical and technical success in non-neoplastic obstructed biliary and pancreatic ducts. Methods Data from patients with an obstructed biliary or pancreatic duct between 01/2021-10/2022 were retrospectively analyzed. Clinical and technical success were the primary endpoints. Adverse events, re-stenosis, and re-intervention were also evaluated ([Table 1]). Results Twenty patients included: 15/20 EUS-guided biliary drainage (EUS-BD) and 5/20 EUS-guided pancreatic duct drainage (EUS-PDD). A) EUS-BD: Anterograde drainage was performed in 7/15 using a single pigtail stent, 5/15 double pigtail stents and 3/15 lumen-apposing metal stent (LAMS). Stomach puncture was the preferred approach site in 12/15. A 15/15 (100%) technical success was achieved, but a 8/15 (60%) clinical success based on bilirubin decrease. During follow-up, adverse events were documented in 5/15 cases: upper GI bleeding, cholangitis, and subhepatic fluid collection. Stent migrated in 3/15 cases. There was no re-stenosis, but reintervention was necessary on 8/15. Survival rate 13/15. B) EUS-PDD: In 3/5 cautery-assisted dilation was required. In 1/5, balloon dilation was also necessary. Used stents: single and double pigtail stents, LAMS, and self-expandable metal stents (SEMS). Technical and clinical success was achieved in 5/5 (100%), with no adverse events [1] [2] [3]. Conclusions Anterograde EUS-BD and EUS-PDD for managing non-neoplastic obstructed biliary and pancreatic ducts are valuable alternatives when ERCP is not feasible. Reintervention after EUS-BD and EUS-PDD appears to be related to stent migration and re-stenosis, respectively. Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Aims To evaluate the real-world effectiveness of an AI-assisted colonoscopy (AI-VCC) and compare the results among experts and non-experts endoscopists (Fig. 1). Methods Consecutive patients ≥45 years old who underwent VCC (11/2020-03/2021). First, a standard HD-VCC was performed. Then, an AI-VCC was performed by a second operator blinded to previous findings. Adenoma detection rate (ADR) was a quality indicator of the procedure. The polyp detection rate (PDR), and the adenoma and polyp miss rates (AMR and PMR, respectively) were also calculated. The results were compared between experts and non-experts endoscopists. NCT04915833 [1] [2] [3] [4] [5] [6] (Fig. 2). Results 115 patients were included. 58/115 (50.4%) had a total of 205 polyps/adenoma, with a PDR and ADR of 132/205 (64.3%) and 73/205 (35.6%) with VCC, respectively: 19/205 (9.3%) NICE II, 7/205 (3.4%) >10 mm. With AI-assistance, the ADR and PDR increased from 16.5% to 18.2% and from 50.4% to 60%, respectively. The ADR increased from 10.8% to 16.2% in the junior group with the AI-VCC. No difference in ADR was observed in the senior cohort ([Table 1]). PMR was 43.13%, AMR was 5.19%. Sensitivity among different colon segments ranged from 56.25% (rectum) to 78.26% (ascending colon). Capability of AI for appropriate polyp and adenoma presence discharging (negative predictive value, NPV) ranged from 61.54% (sigmoid) to 89.09% (cecum). Lower rates for specificity (8.42-49.49%) and PPV (9.89-19.78%) were observed due to high false positives. ([Table 2]). Conclusions Junior endoscopists benefit from the AI-assisted polyp detector during screening colonoscopy as it helps them achieve an ADR comparable to that of senior endoscopists. Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany