Acute pancreatitis is the most common major complication after endoscopic retrograde cholangiopancreatography (ERCP). Many drugs have been evaluated for prophylaxis, including nonsteroidal anti-inflammatory drugs (NSAIDs), which are potent inhibitors of phospholipase A2 and play a role in the pathogenesis of acute pancreatitis. Rectal NSAIDs have been shown in prospective studies to decrease the incidence of this complication, but the indication is not generalized in clinical practice. The aim of this study was to evaluate the efficacy of rectal administration of indomethacin in reducing the incidence of post-ERCP pancreatitis in high-risk patients. This was a controlled clinical trial where patients with an elevated risk of developing post-ERCP pancreatitis were assigned to receive 100 mg of rectal indomethacin or a 2.6 g suppository of glycerin immediately after ERCP, without placement of a pancreatic stent. The patients were determined to be at high risk based on validated patient- and procedure-related risk factors. Post-ERCP pancreatitis was defined as the presence of new upper abdominal pain, hyperamylasemia/hyperlipasemia (at least three times the upper limit) 2 hours after the procedure and hospitalization at least 48 hours because of the complication. Pancreatitis severity was defined according to Cotton’s criteria. One hundred sixty-six patients were included; 82 in the study group and 84 in the placebo group. Patients had at least one major and/or two minor risk factors for developing post-ERCP pancreatitis. The incidence of the complication was 4.87 % (4/82) in the study group and 20.23 % (17/84) in the placebo group; this difference was significant (P = 0.01). According to Cotton’s criteria, 17 patients (80.9 %) developed mild pancreatitis and 4 (19.1 %) had moderate pancreatitis; 3 of these 4 patients belonged to the placebo group (P = 0.60). Based on these results, an absolute risk reduction of 0.15 (15 %), a relative risk reduction of 0.75 (75 %) and a number needed to treat of 6.5 patients were calculated to prevent an episode of post-ERCP pancreatitis. There was no mortality. Rectal indomethacin reduced the incidence of post-ERCP pancreatitis among patients at high risk of developing this complication. National Clinical Trials NCT02110810 . Date April 7, 2014.

Oral glutamine reduces myocardial damage after coronary revascularization under cardiopulmonary bypass. A randomized clinical trial

Chronic migraines have been described chiefly only from a clinical perspective. However, searching for reliable molecular markers has allowed for the discovery of the expression of different genes mainly associated with inflammation, neuro-vascularization, and pain-related pathways. The interest in microRNAs (miRs) that can regulate the expression of these genes has gained significant relevance since multiple miRs could play a key role in regulating these events. In this study, miRs were searched in samples from patients with chronic migraine, and the inclusion criteria were carefully reviewed. Different bioinformatic tools, such as miRbase, targetscan, miRPath, tissue atlas, and miR2Disease, were used to analyze the samples. Our findings revealed that some of the miRs were expressed more (miR-197, miR-101, miR-92a, miR-375, and miR-146b) and less (miR-133a/b, miR-134, miR-195, and miR-340) than others. We concluded that, during chronic migraine, common pathways, such as inflammation, vascularization, neurodevelopment, nociceptive pain, and pharmacological resistance, were associated with this disease.

Introduction: Malnutrition is a critical issue among cancer patients, leading to adverse clinical outcomes, including increased treatment toxicity, reduced physical function, and decreased survival. Nutritional screening is essential to identify patients at risk and provide timely interventions. Objectives: This study aimed to assess the effectiveness of various nutritional screening tools in identifying the risk of malnutrition and obesity in Mexican cancer outpatients. Methods: A cross-sectional study was conducted with 396 adult cancer outpatients at a public hospital in Mexico. Nutritional risk was evaluated using NRS-2002, MUST, MST, NUTRISCORE, and PG-SGA, while malnutrition was assessed using GLIM criteria and PG-SGA. Anthropometric and demographic data were collected. Sensitivity, specificity, and kappa coefficients were calculated to determine the performance of the screening tools. Results: Nutritional risk was identified in 22.7–26.5% of patients, with the highest agreement observed between MUST and PG-SGA (k = 0.64). Malnutrition prevalence was higher using GLIM criteria (37.4%) compared to PG-SGA (25.8%, p < 0.001). Overweight and obesity affected 37.1% and 23.5% of patients, respectively. Low BMI and reduced HGS were strongly associated with nutritional risk and malnutrition (p < 0.001). Conclusions: MUST and PG-SGA are reliable tools for nutritional screening in cancer outpatients, while GLIM criteria detect a higher prevalence of malnutrition than PG-SGA. The high rates of overweight and obesity highlight the complex nutritional challenges in this population, emphasizing the need for tailored nutritional assessments and interventions.

Background: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant’s first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 586 postpartum women who completed an online survey 4−8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 0.001, respectively). Conclusions: Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.