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BACKGROUND AND AIMS: The Rome Foundation Global Epidemiology Study (RFGES) assessed the prevalence, burden, and associated factors of Disorders of Gut-Brain Interaction (DGBI) in 33 countries around the world. Achieving worldwide sampling necessitated use of two different surveying methods: In-person household interviews (9 countries) and Internet surveys (26 countries). Two countries, China and Turkey, were surveyed with both methods. This paper examines the differences in the survey results with the two methods, as well as likely reasons for those differences. METHODS: The two RFGES survey methods are described in detail, and differences in DGBI findings summarized for household versus Internet surveys globally, and in more detail for China and Turkey. Logistic regression analysis was used to elucidate factors contributing to these differences. RESULTS: Overall, DGBI were only half as prevalent when assessed with household vs Internet surveys. Similar patterns of methodology-related DGBI differences were seen within both China and Turkey, but prevalence differences between the survey methods were dramatically larger in Turkey. No clear reasons for outcome differences by survey method were identified, although greater relative reduction in bowel and anorectal versus upper gastrointestinal disorders when household versus Internet surveying was used suggests an inhibiting influence of social sensitivity. CONCLUSIONS: The findings strongly indicate that besides affecting data quality, manpower needs and data collection time and costs, the choice of survey method is a substantial determinant of symptom reporting and DGBI prevalence outcomes. This has important implications for future DGBI research and epidemiological research more broadly. ispartof: NEUROGASTROENTEROLOGY AND MOTILITY vol:35 issue:6 ispartof: location:England status: accepted

Roofing systems use different materials that require inclinations according to the typology, shapes and dimensions of the roof, but are exposed to different agents of degradation. In Brazil, it is not common to use treatments to reduce the water absorption of roofs in order to guarantee the performance and durability of roofing systems. This research aimed to determine the water absorption index of ceramic, concrete and fiber cement roofing, according to the effectiveness of two different types of treatments, whose function is to reduce water absorption on the roof of the roofing system. The methodology was based on the analysis of the water absorption in the coverings, in a cyclical way of wetting and drying during 12 days. To meet the cyclical effect, a simulation of rainfall was applied to the roofing systems, with exposure for 45 minutes in each type of roofing with and without the use of two different treatments, that is, a silane-siloxane and an acrylic paint at acrylic resin base. The results indicated that the untreated tiles absorb a high percentage of water when compared to the treated coverings. As for the types of coatings, when analyzed with acrylic paint, they obtained a lower water absorption rate when compared to coatings treated with silane-siloxane. It can be concluded that the use of treatments such as water repellent or acrylic paint on ceramic, concrete and fiber cement coverings reduces their permeability and decreases the rate of water absorption, and the acrylic paint obtained better results in relation to water repellent and roofs not treated.

La gestión sostenible normaliza los valores éticos y medioambientales que sirven para el desarrollo y potencialidad de las comunidades. El problema abordado en este trabajo fue lograr una gestión sustentable mediante la evaluación de las fallas del emprendimiento con el fin de diversificar la oferta turística del destino de las Siete Cascadas en el cantón Naranjal. El principal objetivo es identificar los elementos que inciden en su desempeño actual para mejorar el servicio prestado. La metodología utilizada fue de tipo mixto (cualitativa y cuantitativa), las técnicas de ambos enfoques se utilizan para medir la relación entre las variables independientes con la variable dependiente, se utiliza el método de juicio de expertos medido por el Coeficiente de Validez de Coincidencia. Para la validación del instrumento diseñado (encuesta tipo test) y la confiabilidad se utilizó el estadístico Alfa de Cronbach, la evaluación de las correlaciones se calculó utilizando el programa SPSS y Microsoft Word Excel. La principal conclusión del mismo radica en la identificación de las carencias de cada una de las dimensiones de la variable principal y la fortaleza que ésta tiene para lograr la diversificación del destino turístico designado, siendo la dimensión de Servicios la más negativa y dentro de esta los indicadores de alquiler de implementos y equipos para cada oferta turística: la gestión de residuos, mala armonización de la iluminación y señalización con el medio ambiente y el sistema de seguridad.

La reactivación turística es considerada como el conjunto de acciones y estrategias que permiten la recuperación de la actividad como tal. Este trabajo presenta un diseño de estrategias con enfoque tecnológico que permitan la reactivación turística asociada al Covid- 19 en la parroquia Ballenita del cantón Santa Elena. La metodología empleada en el desarrollo de esta investigación está determinada con la aplicación del método descriptivo con un enfoque de investigación cualitativo con el empleo de encuestas dirigidas a los trabajadores del área turística de la parroquia Ballenita, donde se utilizó como instrumento para la recolección de la información un cuestionario ad-hoc de modalidad on line elaborado en Google form. Se elaboraron estrategias, las cuales están enfocadas en impulsar y promocionar el turismo a fin de fortalecer la imagen del sector, el mismo que permitirá el mejoramiento y aprovechamiento de los recursos, considerando que la aplicación correcta de la propuesta permitirá el incremento de visitantes y turistas que lleguen a la zona favoreciendo su reactivación.

Arterial hypertrophy and remodeling are adaptive responses present in SAH that can result in silent ischemia and neurodegeneration, compromising brain connections and cognitive abilities. However, antihypertensives can minimize these histological changes. We try to assess whether cerebrovascular hemodynamic parameters, representative of these histological adaptations, can identify cognitive impairment in a preclinical stage in chronic hypertensive on drug treatment. Three groups of patients without cognitive complaints were prospectively compared: hypertensive under treatment with systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90 mmHg (n=54), hypertensive under treatment with SBP > 140 or DBP >90 mmHg (n=31) and volunteers normotensive (n=30). Simultaneous measurements of systemic BP and middle cerebral artery (MCA) blood flow velocity were obtained from digital plethysmography and Transcranial Doppler. For the cognitive assessment, the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and a broad neuropsychological battery were applied. In relation to normotensive, uncontrolled hypertensive were older (51 ± 12 years), had greater resistance-area product (RAP 1.7 [±0.7] vs. 1.2 [±0.2], p< 0.001), but did not differ in relation to the pulsatility indices (p=0.361). There was a negative correlation between RAP, episodic memory (r = -0.277, p=0.004) and cognitive processing speed (r = -0.319, p=0.001). In chronic hypertensive using antihypertensive, the RAP is a reliable marker of preclinical cognitive decline in specific domains, as it is less influenced by the direct action of these drugs, and should be further explored as an alternative tool for screening for cognitive impairment in these individuals.

Introducción: la enfermedad por reflujo gastroesofágico (ERGE) refractaria puede conducir a complicaciones potenciales como la esofagitis persistente, estenosis esofágica, anillo de Schatzki y esófago de Barrett. Este estudio describe la motilidad en pacientes con ERGE refractaria y su relación con síntomas esofágicos. Método: se realizó un estudio observacional analítico a partir de una cohorte retrospectiva en pacientes con diagnóstico de ERGE refractaria y síntomas esofágicos a quienes se les realizó manometría esofágica de alta resolución más impedanciometría. Se describen las características clínicas y demográficas, y la asociación entre los trastornos manométricos y los síntomas esofágicos. Resultados: se incluyeron 133 pacientes (edad promedio: 54,1 ± 12,5 años). La pirosis y regurgitación (69,2 %) y la disfagia esofágica (13,5 %) fueron los síntomas más comunes. La motilidad normal (75,2 %), el aclaramiento completo del bolo (75,2 %) y la motilidad esofágica inefectiva (MEI) (18 %) fueron los hallazgos manométricos más frecuentes. La unión gastroesofágica tipos II y IIIb estuvieron presentes en el 35,3% y 33,8 % de los casos, respectivamente. La aperistalsis (3,8 %) y el esófago en martillo neumático (Jackhammer; 0,8 %) fueron infrecuentes. El aclaramiento incompleto del bolo se asoció con disfagia esofágica (p = 0,038) y a MEI (p = 0,008). Ningún síntoma esofágico se relacionó significativamente con trastornos de motilidad. Conclusiones: los resultados de nuestro estudio sugieren que los trastornos de motilidad son infrecuentes en los pacientes con ERGE refractaria. Adicionalmente, sugieren que la presencia de alteraciones de motilidad esofágica no se relaciona con la presencia de síntomas esofágicos y, por tanto, que el tipo de síntoma presentado no permite predecir la existencia de dichos trastornos.

Resumen La enfermedad por reflujo gastroesofágico (ERGE) se define como el tránsito anormal del contenido gástrico hacia el esófago, que se da por una alteración de la barrera antirreflujo, causando síntomas o complicaciones. Para su correcto diagnóstico y abordaje terapéutico, se requiere de la integración de hallazgos clínicos, endoscópicos y monitorización del pH esofágico en 24 horas con o sin impedanciometría, la cual debe ser realizada con especificaciones técnicas, y su interpretación debe basarse en la mejor evidencia clínica disponible, con el objetivo de tener diagnósticos precisos que permitan tomar las mejores decisiones con los pacientes. Recientemente, en el Consenso de Lyon se han incorporado nuevas directrices para el diagnóstico de ERGE por monitorización de pH esofágico, las cuales se revisan en este artículo. Abstract Gastroesophageal reflux disease (GERD) is defined as the abnormal transit of gastric contents into the esophagus. It is caused by an alteration of the anti-reflux barrier, causing multiple symptoms or complications. In order to achieve accurate diagnosis and proper therapeutic approach, integration of clinical findings, endoscopic findings and 24-hour esophageal pH monitoring, with or without impedancometry, is required. These tests must be performed following technical specifications and their interpretation must be based on the best clinical evidence available to obtain accurate diagnoses that allow making the best decisions to the benefit of patients. Recently, the Lyon Consensus incorporated new guidelines for the diagnosis of GERD by esophageal pH monitoring, which are reviewed in this paper.

Introduction and aims: Jackhammer esophagus is a recently identified motility disorder. Experience with the novel pathologic condition has been reported in different studies but there is little information on the subject in Latin America. Our case series conducted in Bogota, Colombia, describes the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics. Materials and methods: A retrospective, observational, cross-sectional study included consecutive patients diagnosed with jackhammer esophagus that were referred for high-resolution esophageal manometry. Their clinical and manometric records were reviewed, and the pertinent information for the present study was collected. Results: Within the study period, 6445 patients were evaluated through esophageal manometry, 27 of whom were diagnosed with jackhammer esophagus (prevalence of 0.42%). The majority of those patients were women (n = 17, 63%) in the sixth decade of life. The most common symptom was regurgitation (n = 17, 63%), followed by dysphagia (n = 15, 56%). The mean distal contractile integral was 9384 (5,095−18,546) mmHg·s·cm. Dysphagia was more common in patients > 60 years of age (79%, p 60 años y regurgitación más frecuente (92%, p

Resumen: Introducción y objetivos: «Jackhammer esophagus» (o esófago en «martillo hidráulico» en español), es un trastorno motor esofágico identificado recientemente. Diversos estudios han descrito su experiencia con este novel padecimiento. Sin embargo, no existe información al respecto en Latinoamérica. Nuestro trabajo describe la prevalencia, características demográficas, clínicas y manométricas en una serie de casos con «jackhammer esophagus» en Bogotá, Colombia. Materiales y métodos: Este es un trabajo observacional retrospectivo de corte transversal. Pacientes consecutivos referidos para manometría esofágica de alta resolución diagnosticados con «jackhammer esophagus» fueron considerados para el estudio. Los expedientes clínicos y manométricos de estos enfermos fueron revisados y la información pertinente extraída. Resultados: Durante el periodo de estudio, 6445 pacientes fueron evaluados con manometría esofágica, 27 fueron diagnosticados con «jackhammer esophagus» (prevalencia 0.42%). La mayor parte, fueron mujeres (n = 17,63%) en la sexta década. El síntoma más común fue la regurgitación (n = 17, 63%), seguido por disfagia (n = 15, 56%). El promedio de contracción distal integral observado fue 9,384 (5,095-18,546) mm Hg-s-cm. Disfagia fue más común (79% p 60 años y regurgitación más frecuente (92%, p 60 years of age (79%, p

Resumen La manometría anorrectal es la técnica más utilizada para evaluar la función anorrectal y así detectar las anormalidades funcionales del esfínter anal y de coordinación anorrectal. En nuestro laboratorio de fisiología realizamos aproximadamente 15 estudios de manometría anorrectal de alta resolución a la semana, por lo que consideramos que es de vital importancia realizarlo de forma adecuada y tener una correcta interpretación. Mediante este artículo deseamos compartir nuestro protocolo de realización de manometría anorrectal de alta resolución con base en la literatura más relevante. Abstract Anorectal manometry is the most commonly used technique to evaluate anorectal functioning and coordination and detect functional abnormalities of the anal sphincter. In our physiology laboratory we perform approximately 15 high resolution anorectal manometry studies each week. We consider that proper performance and correct interpretation are vitally important. We want to share our high resolution anorectal manometry protocol based on the most relevant literature through this article.

Intestinal tuberculosis and Crohn's disease are a diagnostic challenge because of the clinical, radiological and endoscopic similarity. The histological and microbiological findings are positive in less than 50%, which delays the correct treatment, putting the patient at risk. We reported a 34-year-old immunocompetent patient with 4 years of malabsorptive diarrhea, weight loss, nocturnal diaphoresis, abdominal pain and an ulcer with stenosis in the jejunum was found; she received empirical anti- tuberculosis treatment with clinical improvement. Later the culture was positive for M. tuberculosis.

Resumo Objetivo analisar a prevalência e os fatores associados à triagem da COVID-19 e propor as estratégias necessárias para a reabertura das Escolas de Enfermagem universitárias para as aulas presenciais. Métodos um estudo transversal foi projetado a partir da linha de base de uma pesquisa longitudinal baseada na Internet de uma Escola Brasileira de Enfermagem. Com o resultado ordinal (classificação operacional COVID-19), a análise de dados foi conduzida usando um modelo de regressão multinomial. Resultados um total de 498 participantes foi incluído na análise e revelou 67,27% de casos suspeitos e 11,65% de casos confirmados de COVID-19. O uso de máscaras, o transporte público e fazer parte da linha de frente dos trabalhadores da saúde foram estatisticamente associados a um histórico positivo para a COVID-19. Conclusão os planos de reabertura de Escolas de Enfermagem devem integrar o uso de equipamentos de proteção pessoal, o transporte público e a triagem da COVID-19 na educação. Resumen Objetivo analizar la prevalencia y los factores asociados al rastreo de COVID-19 y proponer las estrategias necesarias para la reapertura de Escuelas Universitarias de Enfermería para clases presenciales. Métodos se diseñó un estudio transversal a partir de la línea de base de una investigación longitudinal basada en Internet de una Escuela Brasileña de Enfermería. Con el resultado ordinal (clasificación operativa COVID-19), se realizó el análisis de datos mediante un modelo de regresión multinomial. Resultados se incluyeron en el análisis un total de 498 participantes que revelaron el 67,27% de los casos sospechosos y el 11,65% de los casos confirmados de COVID-19. El uso de máscaras, el transporte público y ser parte de la primera línea de los trabajadores de la salud se asociaron estadísticamente con un historial positivo de COVID-19. Conclusión los planes de reapertura de Escuelas de Enfermería deben integrar el uso de equipos de protección personal, transporte público y el rastreo de COVID-19 en la educación. Abstract Objective to analyze the prevalence and factors associated with COVID-19 screening and propose the necessary strategies for the reopening of university Nursing Schools to face-to-face classes. Methods aa cross-sectional study was designed from the baseline of a longitudinal Internet-based survey of a Brazilian School of Nursing. With the ordinal outcome (COVID-19 operational classification), data analysis was conducted using a multinomial regression model Results a total of 498 participants were included in the analysis and revealed 67.27% suspected and 11.65% confirmed cases of COVID-19. Wearing masks, public transportation, and being part of frontline healthcare workers were statistically associated with a positive history for COVID-19. Conclusion plans to reopen Nursing Schools must integrate the use of personal protective equipment, public transportation, and COVID-19 screening into education.

Purpose: To compare augmentation index (AIx) between one Moderate-intensity continuous physical exercise (MICPE) and one High-intensity interval physical exercise (HIIPE) session in normal/high normal blood pressure (BP) (120–140 for systolic and 80–90 mmHg for diastolic). Additionally, to compare two AIx methods (SphygmoCor® and Arteriograph®) [1]. Methods: Exercise intensity and energy expenditure (equalizing) were according to the cardiopulmonary stress test. Individuals were randomized to exercise sessions, performed as cross-over. AIx were analyzed at baseline, immediately after and 24hours after MICPE and HIIPE session and compared among all times. ΔAIxHIIPE (AIxHIIPE - AIxBaseline) and ΔAIxMICPE were calculated. Correlation and agreement analysis was performed between AIx methods. Results: Individuals (n = 23; 78% women; 48 ± 1 years; systolic/diastolicBP = 125 ± 2/84 ± 1 mmHg) had lower AIxSphygmoCor® at MICPE compared to baseline and to 24 hours MICPE (27.2 ± 2.2 vs 32.8 ± 1 and 31.0 ± 2.5%; p < 0.01). AIxSphygmoCor® was lower in HIIPE than other times (23.2 ± 2.4 vs baseline 32.8 ± 1.9 p < 0.01; vs MICPE 27.2 ± 2.2; p = 0.039; vs 24 hours MICPE 31.0 ± 2.5; p < 0.01 and vs 24 hours HIIPE 32.2 ± 2.0%; p < 0.01). AIxArteriograph® was lower in HIIPE (16.0 ± 3.7%) than baseline (28.9 ± 3.4%; p = 0.001), 24 hours MICPE (25.7 ± 4.0%; p = 0.008) and 24 hours HIIPE (29.5 ± 3.9%; p = 0.005). ΔAIxHIIPE was greater than ΔAIxMICPE (−9.37 vs −5.15; p = 0.028). AIxArteriograph® showed a positive correlation with AIxSphygmoCor® (r = 0.793; p < 0.01) and showed agreement. Conclusion: Regardless of intensity, one exercise session improves AIx. The effect seems to be greater after HIIPE than MICPE.

Increased salt consumption is believed to induce high blood pressure (BP)-mediated organ damage, although it is not yet clear whether it reflects a generalized micro- and macrovascular malfunction independent of BP. Exceeding dietary sodium intake is acknowledged to be the main modifiable environmental risk factor for cardiovascular events that accounts for an increase in blood pressure and induces hypertension (HTN)-related target organ damage. Arterial stiffness is well known as an independent cardiovascular risk factor, and sodium intake may be a determinant of arterial stiffness. Even so, the studies that investigated the effect of dietary sodium reduction intake on arterial stiffness in humans provided inconclusive results. Therefore, we aim to perform a review of the available evidence of salt restriction and arterial stiffness and its impact on hypertensive patients.

Introduction: Association between male pattern baldness, also called androgenetic alopecia (AGA) and risk of coronary artery disease has been suggested by several epidemiological studies. Exogenous testosterone (T) therapy in transgender men (TM) promotes the development of alopecia in genetically susceptible individuals, and increases facial and body hair, muscle mass (MM) and visceral fat. The outcome of a long-term androgenic therapy over the functional properties of large arteries and the cardiovascular system of TM are not well stablished. Objective: To investigate the possible association between AGA and arterial stiffness assessed by measurement of carotid-femoral pulse wave velocity (VOPcf) and intima-media thickness carotid artery (cIMT) in TM receiving long-term T therapy. Methods: Forty-six TM (mean age: 43 ± 10 yo) undergoing T therapy (mean time of treatment duration: 13 ± 10 y; mean serum T levels: 611 ± 439 ng/dL) were evaluated in a cross-sectional study. Hair pattern (Ferriman & Gallway scale), grades of male pattern baldness (Hamilton-Norwood scale) and waist-hip ratio (WHR) were analyzed. Subjects were considered to have AGA if they have vertex alopecia (grade ≥ 3). Arterial Hypertension was defined as systolic blood pressure > 140 and/or diastolic blood pressure > 90mmHg or under pharmacological treatment, and dyslipidemia as total cholesterol ≥ 240 mg/dL and/or LDL-c≥ 160 mg/dL and/or HDL-c < 40 mg/dL and/or triglycerides > 200 mg/dL, or under pharmacological treatment. Current smoking has been investigated. The aortic stiffness, assessed by VOPcf and cIMT, was measured using the Complior® device and carotid ultrasound, respectively. Results: TM’s Ferriman degree was 21 ± 6 and AGA was identified in 70% of them. The WHR was 0.9 ± 0.1. TM with AGA showed higher cIMT than TM without AGA (0.66 ± 0.1mm vs. 0.54 ± 0.07mm, p = 0.001), as well as higher WHR (0.93 ± 0.08 vs.0.87 ± 0.04, p = 0.02), higher score in terminal body hair (Ferriman 23 ± 6 vs. 18 ± 6, p = 0.007) and higher frequency of hypertension (94% vs. 6%, p = 0.01). The cIMT positively correlated with age (p = 0.01) and WHR (p = 0.002). The VOPcf was positively correlated with the age (p = 0.0001), androgen treatment duration (p = 0.01) and WHR (p = 0.04). There was a positive correlation between androgen treatment duration and WHR (p = 0.01). There was no difference in the VOPcf values, age, T treatment duration, serum T levels, frequency of dyslipidemia and smoking between the groups. Conclusion: The severe vertex AGA pattern may be considered a possible marker of arterial stiffness in TM undergoing long-term testosterone therapy.

Cerebral autoregulation (AR) keeps cerebral blood flow constant despite fluctuations in systemic arterial pressure. The final common AR pathway is made up of vasomotor adjustments of cerebrovascular resistance mediated by arterioles. Structural and functional changes in the arteriolar wall arise with age and systemic arterial hypertension. This study evaluated whether AR is impaired in hypertensive patients and whether this impairment differs with disease control. Three groups of patients were prospectively compared: hypertensive patients under treatment with systolic blood pressure (SBP) 140 or DBP > 90 mm Hg (n = 31), and normotensive volunteers (n = 30). Simultaneous measurements of cerebral blood flow velocity (CBFV) and BP were obtained by digital plethysmography and transcranial Doppler, and the AR index (ARI) was defined according to the step response to spontaneous fluctuations in BP. Compared to the uncontrolled hypertension, the normotensive individuals were younger (age 43.42 ± 11.14, P