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(37, '32983272', '2021-06-10 13:35:48', '2020-08-23', 'si', 'JUAN MANUEL', 'MONTERO', '32983272', 'OBSERVACIONAL', 'Prevalencia de Enfermedad por Reflujo en Pacientes con Esofagitis Los Angeles A/B', 'Montero Juan Manuel', 'Maria Marta Pizkors', 'Maria Marta Pizkors', '', '', '', '', '', 'La enfermedad por Reflujo Gastroesofágico (ERGE),  es una enfermedad con un interés global en ascenso desde 1980. A lo largo del tiempo la misma debió pasar por varias definiciones y consensos como los de GENVAL 1988 (1) y los de Montreal en 2006 (2) (3). En estas guías ERGE se define, por consenso, como la presencia de síntomas y/o complicaciones resultantes del reflujo del contenido gástrico en el esófago, la cavidad oral, la laringe y/o los pulmones (4). En la argentina la prevalencia es del 23 %, de estos el 60 % suelen tener una endoscopia digestiva alta no patológica, lo que la clasifica como enfermedad por reflujo no erosiva (ERNE), mientras que un 35 % presento un enfermedad por reflujo erosiva (ERE), de los cuales el 80 % fueron formas leves o moderadas (clasificación de Los Ãngeles A-B) y un 20 % severas (Clasificación de los Las Ãngeles C-D) y 5 % esófago de Barrett. (3) (5)\r\n\r\nLa ERGE es una entidad multifactorial en cuya fisiopatogenia interactúan el contenido gástrico (ácido, pepsina, sales biliares, enzimas pancreáticas), la barrera antirreflujo en la Unión Gastroesofágica (UGE), y mecanismos de defensa y reparación del epitelio esofágico. Cuando la barrera antirreflujo se ve superada con frecuencia tal que los mecanismos de defensa se vuelven insuficientes, el paciente desarrolla ERGE. (5) (6)\r\n\r\nSegún los Ãngeles se clasifica el ERGE en forma endoscópica desde Los Ãngeles A-D, entendiendo como A erosiones menores a 5 mm, B mayor o igual 1 erosión > 5 mm sin continuidad entre 2 pliegues, C > igual a 1 erosión con continuidad entre > igual a 2 pliegues que ocupa < 75 % de la circunferencia, D Erosiones o ulceras que ocupan > 75 % de la circunferencia del esófago. (7)\r\n\r\nEn los últimos años con el advenimiento de la técnicas como la manometría esofágica, la cual  permite valorar alteraciones en la motilidad esofágica que justifiquen la presencia de ERGE y La pH impedanciometría de 24 hs que permite valorar la exposición esofágica de ácido en periodo de un día, permite hacer diagnóstico de la causa probable de ERGE. Existe poca bibliografía en la literatura que logre asociar los hallazgo en la PH impedanciomentría y la MEAR con el grado de lesión evidenciado por la clasificación de los Ãngeles. La idea del nuestro trabajo es poder probar que grado de asociación real existe entre la clasificación de los Ãngeles en sus grados leves (A-B) y la presencia o no de ERGE evidenciado por Ph-Impedanciometría.\r\n', 'Pacientes Con Esofagitis Los Angeles A-B\r\n', 'PH/Impedanciomentria', '-', 'Establecer Prevalencia de ERGE en esofagitis Los Angeles A-B\r\n', 'Estimar la prevalencia de enfermedad por reflujo en las esofagitis los Ãngeles a-b\r\n\r\n', 'Establecer un valor pretest de dicha clasificación para sospechar ERGE', NULL, 'OBSERVACIONAL', NULL, 'DESCRIPTIVO', NULL, NULL, NULL, 'Pacientes entre 21 y 50 años que consulten por ERGE, a los cuales se le realizó una PH impedanciomentría, con VEDA previa con Esofagitis Los Ãngeles A-B. ', 'No firmar el consentimiento informado debido a falta de interés o presentar impedimento legal, Embarazadas, Pacientes con ERGE, con endoscopias Previas con Esofagitis Los Ãngeles C-D o enfermedad de Barret, Pacientes con ERNE, Pacientes con comorbilidades graves mal controladas (insuficiencia cardiaca, pulmonar, hepática o renal severas, DBT mal controlada, enfermedades tiroideas, neurológicas).', 'Pacientes a los que se diagnostique patología orgánica diferente de ERGE en la VEDA realizada, Esofagitis Eosinofílica a través de las biopsias, Desórdenes con Obstrucción de Salida de la UEG (Acalasia, Obstrucción de salida de la UGE) o Desórdenes Mayores de la Peristalsis (Espasmo Esofágico Distal,  Esófago de Jackhammer, Ausencia de contractilidad) en la MEAR, pacientes que no se realicen los estudios solicitados o abandonen el seguimiento. ', '', '', '', 'El estudio se realizará  en la Sección Neurogastroenterología del Servicio de Gastroenterología del Hospital de Clínicas José de San Martín entre los meses de junio 2018 y Agosto de 2021.', '', 'Enfermedad por Reflujo Gastroesofágico (ERGE)\r\nSe considerará ERGE a la presencia, en la pH-impedanciometría, de tiempo de exposición ácida (TEA) esofágico patológico (pH < 4 por > 4.2% de la duración del estudio) y/ o a la presencia de fracaso de barrera (> 73 episodios de reflujo totales durante el periodo de monitoreo).  \r\nLos pacientes con ERGE se dividirán, según el resultado de la Video Endoscopía Digestiva Alta (VEDA), en Enfermedad por Reflujo Erosiva (ERE) y Enfermedad por Reflujo No Erosiva (ERNE).\r\n- Enfermedad por Reflujo (cualitativa dicotómica):\r\nERE: Con daño mucoso esofágico evidente (erosiones) en el examen endoscópico. \r\nERNE: Sin daño mucoso esofágico evidente (erosiones) en el examen endoscópico. \r\nSíntomas (cualitativa dicotómica)\r\n- Pirosis: Sensación de ardor retroesternal.\r\n- Regurgitación: Contenido ácido o amargo que asciende hacia el esófago.\r\n- Dolor torácico: Sensación de opresión retroesternal. \r\n- Disfagia: Sensación de dificultad en el pasaje del material deglutido.\r\nOrofaringea: Dificultad para iniciar la deglución.\r\nEsofágica: Sensación de atascamiento del material deglutido en la región retroesternal. \r\n- Eructo: Expulsión oral de un bolo de gas desde el tracto gastrointestinal alto. \r\n- Tos crónica: Presente por ≥ 3 semanas.\r\n- Globus faríngeo: Sensación de cuerpo extraño en la garganta.\r\n- Disfonía: Alteración del timbre de la voz. \r\nHallazgos endoscópicos\r\n- Hernia Hiatal (cualitativa dicotómica)\r\nPresencia: Distancia ≥ 2 cm entre el hiato diafragmático y la Unión Gastro-Esofágica (UGE).\r\nAusencia: Distancia < 2 cm entre el hiato diafragmático y la UGE.\r\n- Esofagitis Erosiva (cualitativa ordinal): Se definirá según la Clasificación de Los Ãngeles (1994).\r\nGrado A: Una o más interrupciones de la mucosa ≤ 5 mm que no se extienden entre la cresta de dos pliegues mucosos.\r\nGrado B: Una o más interrupciones de la mucosa > 5 mm que no se extienden entre la cresta de dos pliegues mucosos.\r\nGrado C: Una o más de las interrupciones de la mucosa que sobrepasan la cresta de dos pliegues mucosos y abarcan < del 75% de la circunferencia esofágica.\r\nGrado D: Una o más de las interrupciones de la mucosa, confluentes entre pliegues mucosos, que  abarcan ≥ 75% de la circunferencia esofágica.\r\n-	Esófago de Barrett (cualitativa dicotómica): Reemplazo del epitelio escamoso distal del esófago normal por epitelio columnar metaplásico, visible endoscópicamente por encima de  la unión esofagogástrica y confirmado por histología.\r\nPresencia: > 1cm de distancia entre UGE y Cambio Mucoso. \r\nAusencia: ≤ 1cm de distancia entre UGE y Cambio Mucoso. \r\n-	Válvula Flap Gastroesofágica (cualitativa ordinal): Consiste en un pliegue músculo-mucoso de 180º, creado por el ángulo de entrada del esófago en el estómago, que se extiende 3-4 cm a lo largo de la curvatura menor. Se utilizará la Clasificación de Hill, según las  variaciones de la misma evidenciadas durante la retrovisión gástrica.\r\nGrado I: Presencia de un pliegue prominente de tejido alrededor del endoscopio, a lo largo de la curvatura menor.\r\nGrado II: El pliegue es menos prominente y, durante la inspiración, se forma un espacio entre el mismo y el endoscopio. \r\nGrado III: El pliegue no es prominente y constantemente existe un espacio entre el mismo y el endoscopio. \r\nGrado IV: No existe pliegue y la luz del esófago se encuentra abierta, lo que permite ver el epitelio escamoso a través de la misma.\r\n\r\nPH-Impedanciometría de 24 horas\r\n-	Exposición ácida esofágica patológica (cualitativa dicotómica)\r\nPorcentaje de tiempo total con pH < 4. \r\nPresencia: pH < 4 por > 4.2% de la duración del estudio.\r\nAusencia: pH < 4 por < 4.2% de la duración del estudio.\r\n-	Impedancia Basal Nocturna Media (cuantitativa continua)\r\nImpedancia de la mucosa esofágica en reposo, en ausencia de degluciones y de eventos de reflujo. Se expresa en Ohms. \r\n- Fracaso de barrera (cualitativa dicotómica): \r\nPresencia: > 73 episodios de reflujo totales durante el periodo de monitoreo.\r\nAusencia: < 73 episodios de reflujo totales durante el periodo de monitoreo.\r\n-	Episodio de reflujo (cualitativa nominal):\r\nÃcido: pH < 4	\r\nDébilmente ácido: pH ≥4 y < 7\r\nDébilmente alcalino: pH ≥7\r\n- Ãndice Sintomático (SI) (cualitativa dicotómica): \r\nNúmero de síntomas relacionados con un episodio de reflujo/ número total de síntomas x 100\r\nExpresa el porcentaje de síntomas relacionados temporalmente con un episodio de reflujo. \r\nPresencia: IS ≥ 50%\r\nAusencia: IS <50%\r\n- Probabilidad de Asociación Sintomática (SAP) (cualitativa dicotómica): Se calcula dividiendo el trazado de pH impedanciometría en segmentos de 2 minutos. Se construye una tabla de 2 x 2  con el número de segmentos de 2 minutos con y sin síntomas, con y sin reflujo. Se realiza un test de chi2.\r\nPresencia: SAP > 95%\r\nAusencia: SAP < 95%\r\n', 'Se realizara un revisión de historios clínicas de pacientes con ERGE que fueron sometidos a Endoscopia digestiva alta, y posteriormente Ph-Impedaciometria, con el fin de establecer la prevalencia existente entre VEDA con Esofagitis los Angeles A- B y la presencia de reflujo acido establecido por Ph-impedanciometria. ', '', '', '', '', '', '', '', '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', '', '', '', '', '', '', '', NULL, '', '', '', '', '', '', '', '', '', NULL, 'si', ''),
(39, '95733511', '2021-05-31 00:47:06', '2020-11-19', 'si', '', '', '', NULL, 'Evaluación de la Respuesta al tratamiento endoscópico en pacientes con Acalasia: cohorte retrospectiva', 'GUTIÉRREZ ARISPE FERNANDA', '', 'Dr. Olmos; Dra. Piskorz', 'La acalasia es un trastorno degenerativo de la motilidad esofágica, debida a la destrucción irreversible de las neuronas del plexo mientérico del esófago (1). Se caracteriza por la ausencia del peristaltismo del cuerpo esofágico y relajaciones incompletas o ausentes del esfínter esofágico inferior (EEI) tras la deglución (2). Es de baja incidencia afecta a ambos géneros con una incidencia de 1/100 000 y una prevalencia de 10/100 000 (3). Atendiendo a su mecanismo etiológico, la acalasia se clasifica en: primaria o idiopática, no relacionada con ningún agente conocido, y secundaria (pseudoacalasia), asociada a una enfermedad sistémica, neuromuscular, metabólica o tumoral, recientemente, se ha añadido la esofagitis eosinofílica (2). En su fisiopatología se han involucrado factores inmunológicos, genéticos, infecciosos y neurodegenerativos, la degeneración de las células ganglionares en el plexo mesentérico y los niveles anormales de óxido nítrico llevan a la obstrucción funcional de la unión gastro-esofágica, acompañada de síntomas como disfagia, acidez, dolor torácico y pérdida de peso. En relación con el diagnóstico, la novedad más importante es la manometría de alta resolución, la disponibilidad de hasta 36 canales de registro permiten obtener una mayor información del comportamiento motor del esófago (2).  Los tratamientos convencionales incluyen terapia médica, inyección de toxina botulínica, dilatación neumática y miotomía de Heller, los dos últimos se definen como opciones de tratamiento definitivas. Las nuevas terapias emergentes incluyen miotomía endoscópica peroral, colocación de stents metálicos autoexpandibles y escleroterapia endoscópica.', 'Evaluar la respuesta de las modalidades terapéuticas endoscópicas \r\nen pacientes con acalasia en un análisis a corto y largo plazo de las opciones de tratamiento.', '•Es un estudio observacional, cohorte retrospectivo; en el cual se seleccionan pacientes con diagnóstico de acalasia, según los criterios de Chicago por medio de la manometría de alta resolución esofágica, a los cuales se les indica un tratamiento y se realiza nuevamente una medición subjetiva a través del score de Eckardt sobre los síntomas clínicos de la acalasia.\r\n•Estudio que comprende el periodo desde 2018 hasta 2022; los datos se obtienen de una base de datos informatizada del servicio de Gastroenterología del Hospital de Clínicas “José de San Martinâ€, de la división de Neurogastroenterología.', 'Edad promedio, síntoma más frecuente, métodos diagnósticos, respuesta a las estrategias terapéuticas a los 3 meses, 6 meses y al año.', '', 'La acalasia idiopática es un trastorno de motilidad primaria poco frecuente del esófago, es un trastorno degenerativo de la motilidad esofágica, debida a la destrucción irreversible de las neuronas del plexo mientérico del esófago (1). Las características clásicas son la relajación incompleta de un esfínter esofágico inferior (EII) frecuentemente hipertensivo y por la ausencia del peristaltismo del cuerpo esofágico tras la deglución (2,5). Su terminología deriva del griego\r\n(α= ausencia, χαλασια= relajación), caracterizado por aperistalsis del cuerpo esofágico y ausencia o pobre relajación del esfínter esofágico inferior en respuesta a la deglución (1). Es de baja incidencia afecta a ambos géneros con una incidencia de 1/100 000 y una prevalencia de 10/100 000 (3).\r\nAtendiendo a su mecanismo etiológico, la acalasia se clasifica en: primaria o idiopática, no relacionada con ningún agente conocido, y secundaria (pseudoacalasia), asociada a una enfermedad sistémica, neuromuscular, metabólica o tumoral, recientemente, se ha añadido la esofagitis eosinofílica (2).\r\nLa alteración fisiopatológica primaria es la pérdida de interneuronas inhibidoras en el plexo mientérico que están involucradas en facilitar la relajación del EEI para el alojamiento gástrico de los bolos de alimentos (5).\r\nPor consiguiente, la presentación sintomática clásica implica disfagia a los sólidos y líquidos asociados con la regurgitación de alimentos no digeridos. Otros síntomas asociados incluyen dolor torácico subesternal con disfagia, pérdida de peso y dispepsia que a menudo conduce a un diagnóstico erróneo de enfermedad por reflujo gastroesofágico (4). Las terapias actuales deben basarse en los resultados de los hallazgos clínicos y otras pruebas de diagnóstico, como estudios de imágenes, esofagogastroduodenoscopia (EGD), manometría, y posiblemente manometría de alta resolución (HRM), las opciones para el tratamiento de la acalasia son enormes con muchas nuevas terapias emergentes. Aunque ninguna opción de tratamiento actual es una cura definitiva, el objetivo es reducir la hipertonicidad del EEI en un esfuerzo por aliviar los síntomas, mejorar el vaciado esofágico y prevenir una mayor dilatación esofágica. (4,5). La disrupción mecánica del esfínter esofágico inferior ya sea por dilatación neumática endoscópica (DNE) ≥ 30 mm o miotomía laparoscópica (ML), brinda un alivio durable de los síntomas. Un ensayo multicéntrico controlado y randomizado reciente, demostró que tanto la DNE como la ML brindan un alivio de los síntomas en el 90% de los pacientes a los 2 años [5]; otro mostró que la DNE y la ML brindan una mejora equivalente en la calidad de vida relacionada con la acalasia a los 5 años (3).', 'Pacientes mayores de 18 años con disfagia esofágica', 'Dilatación hidráulica e inyección con toxina botulínica', 'Dilatación hidráulica vs Inyección de toxina botulínica', 'Mejor respuesta clínica de la disfagia las intervenciones endoscópicas', 'Evaluar la respuesta de las modalidades terapéuticas endoscópicas en pacientes con acalasia en un análisis a corto y largo plazo de las opciones de tratamiento.', 'Comparar la mejoría clínica y la calidad de vida en pacientes tratados con las modalidades terapéuticas.', NULL, 'OBSERVACIONAL', NULL, 'DESCRIPTIVO', NULL, NULL, NULL, '•Mayores de 18 años con diagnóstico de acalasia en seguimiento por el servicio de Neurogastroenterología del HCJSM.\r\n•Presentar videoendoscopia digestiva alta (VEDA) que permita descartar obstrucción orgánica y laboratorio completo con el objeto de descartar trastornos metabólicos.\r\n•Diagnóstico de acalasia realizado a través de manometría de alta resolución esofágica.', '•No firmar el consentimiento informado debido a falta de interés o presentar impedimento legal por causas como demencia de cualquier etiología o trastornos psiquiátricos.\r\n•Embarazadas.\r\n•Cualquier etiología orgánica de obstrucción a nivel de esófago.', '', 'Mayores de 18 años', '', '', '', '', '', '', '', '', '', '', '', '', '', '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', '', '', '', '', '', '', '', NULL, '', '', '', '', '', '', '', '', '', NULL, 'si', '1.Jiménez Ramos R, Roque González R, Anido Escobar V. Estrategias terapéuticas en el tratamiento de la acalasia esofágica. Rev Cuba Cir. diciembre de 2015;54(4):0-0. \r\n2.Ruiz de León San Juan A, Pérez de la Serna y Bueno J. Acalasia. Nuevos conceptos. Med Clínica. mayo de 2017;148(10):453-5. \r\n3.WrightAS EA. Acalasia: un estudio poblacional - Artículos - IntraMed [Internet]. 2017 [citado 9 de septiembre de 2019]. Disponible en: https://www.intramed.net/contenidover.asp?contenidoid=91541\r\n4.Vaezi M, Krill J, Naik R. Clinical management of achalasia: current state of the art. Clin Exp Gastroenterol. abril de 2016;71. \r\n5.Eckardt AJ, Eckardt VF. Current clinical approach to achalasia. World J Gastroenterol WJG. 28 de agosto de 2009;15(32):3969-75. \r\n6.Vaezi MF, Pandolfino JE, Vela MF. ACG Clinical Guideline: Diagnosis and Management of Achalasia: Am J Gastroenterol. agosto de 2013;108(8):1238-49. \r\n7.Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: A New Clinically Relevant Classification by High-Resolution Manometry. Gastroenterology. noviembre de 2008;135(5):1526-33.'),
(40, '29973043', '2021-07-28 15:49:27', '2021-01-12', 'si', '', '', '', 'OBSERVACIONAL', 'PARAMETROS INFLAMATORIOS EN PACIENTES CON SME INTESTINO IRRITABLE VARIEDAD DIARREA SEGÚN  DISTINTOS NIVELES DE SEVERIDAD Y COMORBILIDADES EMOCIONALES.', 'SOTO JESICA', '', '', '', '', '', '', '', 'El SII se caracteriza por la presencia de dolor abdominal recurrente asociado a alteraciones del ritmo deposicional, ya sea en forma de estreñimiento, de diarrea, o de ambas; la hinchazón y la distensión abdominal son muy frecuentes en el SII De acuerdo con los criterios de, Roma IV, el SII se diagnostica por la presencia de dolor abdominal recurrente que debe estar presente al menos un día a la semana, con dos o más de las siguientes características: a) se asocia a la defecación; b) está relacionado con un cambio en la frecuencia de las deposiciones; y c) está relacionado con un cambio en la consistencia de las deposiciones. En cuanto a los requerimientos de duración de las molestias, hay que tener en cuenta que los criterios deben cumplirse durante los últimos tres meses y los síntomas, haber comenzado un mínimo de seis meses antes del diagnóstico.', 'PACIENTES CON SINDROME INTESTINO IRRITABLE VARIEDAD DIARREA', 'NO', 'CONTROLES SANOS, SINDROME INTESTINO IRRITABLE CON DIFERENTES GRADOS DE SEVERIDAD, SINDROME INTESTINO IRRITABLE CON DIFERENTES COMORBILIDADES', 'NIVELES DE INFLAMACION MEDIDAS POR CITOQUINAS PRO Y ANTIINFLAMATORIAS ', 'COMPARAR LOS PACIENTES CON SINDROME INTESTINO IRRITABLE VARIEDAD DIARREA SEGÚN SEVERIDAD CON RESPECTO A PARAMETROS DE INFLAMACION.', '', NULL, 'OBSERVACIONAL', NULL, 'DESCRIPTIVO', NULL, NULL, NULL, 'Pacientes masculinos o femeninos  mayores de 21  con diagnóstico de síndrome de intestino irritable según los criterios de Roma IV.', 'Pacientes menores de 21 años.\r\nPacientes con otras enfermedades sistémicas como enfermedad orgánica del tracto gastrointestinal, insuficiencia cardíaca, renal o hepática, antecedentes conocidos de cirugía  del tracto gastrointestinal, diabetes mellitus, cirrosis, enfermedad inflamatoria intestinal, enfermedad celíaca.\r\nPacientes con deterioro cognitivo abuso de alcohol\r\nFalta de adhesión al  consentimiento informado.\r\n', '', '', '', '', 'Se reviso las historias clínicas electrónica del Servicio de Neurogastroenterologia del Hospital de Clínicas Jose de San Martin evaluando escalas de ansiedad y depresión, laboratorio, desde …….hasta 31/04/2021', '', '', '', '', '', '', '', '', '', '', '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', '', '', '', '', '', '', '', NULL, '', '', '', '', '', '', '', '', '', NULL, 'si', ''),
(41, '95495960', '2021-01-20 21:51:54', '', 'si', '', '', '', NULL, 'UTILIDAD DE LA ECOGRAFIA TRANSPERINEAL EN EL DIAGNOSTICO DE LA OBSTRUCCION FUNCIONAL AL TRACTO DE SALIDA DEL PISO PELVIANO', 'Jonathan David Salmon Pico', '', '', '', '', '', '', '', 'El piso pélvico es un aparato muscular complejo que cumple tres funciones importantes: defecación, micción y función sexual1.\r\nLa prevalencia de defecación disinérgica entre los pacientes con estreñimiento crónico ha variado ampliamente, del 20% al 81%, esta puede sobreestimarse debido a las altas tasas de falsos positivos observadas en algunos estudios. La disinergia fue 3 veces mayor en mujeres que en hombres, pero fue similar en individuos más jóvenes y mayores. \r\nLa defecación disinérgica tiene un impacto en la calidad de vida de los pacientes alterando sus actividades diarias, genera un impacto económico considerable debido a medicamentos, hospitalizaciones, servicios ambulatorios, visitas de emergencia y pruebas de laboratorio. \r\nLa etiología de la defecación disinérgica no está clara. La ansiedad y / o el estrés psicológico también pueden contribuir al desarrollo de la defecación disinérgica al aumentar la tensión del músculo esquelético. Previo a establecer el diagnóstico de defecación disinérgica se debe excluir  trastornos metabólicos o patologías subyacentes. \r\nLos criterios de diagnóstico de ROMA IV para los trastornos de defecación funcional son: 1. Diagnóstico de estreñimiento funcional y / o el síndrome del intestino irritable variedad constipación. 2. Evacuación deficiente, como lo demuestran 2 de las siguientes 3 pruebas: a. Prueba anormal de expulsión del balón, b. Patrón anormal de evacuación anorrectal con manometría o electromiografía de superficie anal, c. Evacuación rectal deteriorada por imagen. Los criterios de diagnóstico para la defecación disinérgica son contracción inadecuada del suelo pélvico medida con electromiografía en la superficie anal o manometría con fuerzas propulsoras adecuadas durante el intento de defecación. Para establecer el diagnostico se necesitan que los criterios se cumplan durante los últimos 3 meses con inicio de síntomas al menos 6 meses antes del diagnóstico2.\r\nEl diagnóstico diferencial incluye muchas anormalidades estructurales o funcionales que también pueden conducir a un trastorno de evacuación como rectoceles, esfínteres anales hipertensivos, hemorroides, fisuras anales, neoplasias anorrectales, prolapso rectal, proctitis, descenso perineal excesivo e invaginación intestinal de la mucosa. Estas condiciones pueden identificarse fácilmente mediante pruebas apropiadas3.\r\nLos métodos diagnósticos incluyen: Manometría anorrectal (MAAR) mide las presiones intrarrectales durante el intento de defecación y la medición de las presiones anales y / o la actividad de electromiografía durante el intento de defecación. El índice de defecación sirve como una medida cuantitativa simple y útil de la coordinación rectoanal durante las defecaciones. Es un método esencial para el diagnóstico de defecación disinérgica.  Se han reconocido al menos cuatro tipos de defecación disinérgica:   Patrón tipo I se caracteriza por un aumento de la presión intrarrectal (≥45 mm Hg) y un aumento de la presión anal que refleja la contracción del esfínter anal. Patrón II propulsión inadecuada (presión intrarrectal <45 mm Hg) puede estar asociada con una contracción paradójica.  Patrón tipo III se caracteriza por un aumento de la presión intrarrectal (≥45 mm Hg) con relajación ausente o insuficiente (<20%) del esfínter anal. Patrón IV un aumento inadecuado de la presión rectal de (<40 mmHg) (fuerza propulsora deficiente) acompañado de un fallo en la reducción de la presión anal ( ≤ 20% de presión de referencia).  \r\nEl test de expulsión del balón es un componente esencial de las pruebas fisiológicas para la defecación disinérgica, se evalúa la expulsión de los globos de agua o aire del recto. Después de la colocación, se le da privacidad al paciente y se le pide que expulse el globo. Se define como normal cuando se puede expulsar un globo en un minuto con esta técnica. Sin embargo, los valores normales para el tiempo de expulsión del balón dependen de la posición del cuerpo y los tipos de globos. Aunque es una prueba de detección útil para la defecación disinérgica debido a su alta especificidad (80-90%), su sensibilidad es baja en un 50%, un estudio de expulsión del balón normal, no siempre excluyen un trastorno de la defecación\r\nEl diagnostico de defecación disinérgica requiere el cumplimiento de los criterios sintomáticos (Roma IV) y manométricos, con otra medida cuantificable como test de expulsión del balón, defecografía, tiempo de transito colónico. Actualmente para certificar el diagnostico de disinergia en pacientes con síntomas compatibles, luego del examen físico realizamos la manometría anorrectal y el test de expulsión del balón. En caso de que estos dos métodos no sean concluyentes se complementa con una videodefecografía o una resonancia magnética nuclear de piso de pelvis dinámica. Recientemente se ha introducido la ecografía transperineal con imágenes en 2D, 3D y 4D, utilizando técnica de doppler color y reconstrucción tomográficas, con maniobras dinámicas, es un método de excelencia para esta patología. En primer lugar, se realiza un estudio bidimensional con corte sagital o longitudinal donde deben abarcar los tres compartimientos, desde la región pubiana hasta el sector que corresponde a la inserción del músculo puborectal, para obtener posteriormente la reconstrucción 3D, 4D del hiato urogenital. Se evalúa en reposo, con maniobras de Valsalva y durante la contracción de los músculos del piso pelviano. En la reconstrucción del plano axial (3D/4D) permite valorar el hiato urogenital. La evaluación ecográfica con reconstrucción tomográfica permite evaluar el ano, el aparato esfinteriano y el hiato del músculo del elevador del ano4.', 'pacientes constipados', 'Eco transperineal - manometría anorrectal-test expulsión del balón', 'Ecografía transperineal vs manometría/ test de expulsión del balón', 'Diagnostico de Disinergia', 'Evaluar la performans diagnostica en la Ecografía transperineal para el diagnóstico de disinergia comparado con la manometría y el test de expulsión de balón ', '', NULL, 'OBSERVACIONAL', NULL, 'DESCRIPTIVO', NULL, NULL, NULL, '-Pacientes entre 21 y 50 años que consulten por constipación que no haya respondido al tratamiento estándar. \r\n-Pacientes mayores de 50 años con constipación tipo OTS y Colonoscopía dentro de los 5 años sin lesiones\r\n', '•	No firmar el consentimiento informado debido a falta de interés o presentar impedimento legal. \r\n•	Embarazadas. \r\n•	Pacientes que no cumplan con el seguimiento o con los estudios solicitados\r\n•	Pacientes con evidencia de enfermedades orgánicas del tubo digestivo (cáncer colorrectal, enfermedad inflamatoria intestinal, enfermedad celiaca, etc.)\r\n•	Pacientes con comorbilidades graves mal controladas (insuficiencia cardiaca, pulmonar, hepática o renal severas, DBT mal controlada, enfermedades tiroideas, neurológicas).\r\n•	Antecedentes de cirugías pelvianas.\r\n•	Diarrea como síntoma dominante', '', 'Pacientes de ambos sexos mayores de 21 años que hayan consultado al Sector Neurogastroenterologia del Hospital de Clínicas José de San Martin (Centro de atención terciaria)', '', '', 'Los datos se recopilaron de la Historia Clínica del Servicio de Neuro gastroenterología del Hospital de Clínicas José de San Martín del 1 de enero de 2017 hasta el 30 de abril de 2021', '', '', '', '', '', '', '', '', '', '', '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', '', '', '', '', '', '', '', NULL, '', '', '', '', '', '', '', '', '', NULL, 'si', ''),
(43, '32988371', '2021-04-08 13:20:22', '2021-03-18', 'si', 'Florencia', 'Molfeso', '32988371', 'EXPERIMENTAL', 'Predictores de respuesta terapeutica en eructos Supragastricos', 'Molfeso Florencia', '', '', '', '', '', '', '', 'El eructo se define como un escape audible de aire del\r\nel esófago o el estómago hacia la faringe. Puede considerarse un trastorno cuando es excesivo y se vuelve problemático. Dependiendo del origen del gas refluido, los eructos se clasifican en 2 tipos: el eructo gástrico y el eructo supragástrico.\r\nLos estudios que utilizan la medición de la ph-impedanciometria intraluminal han demostrado que se producen diferentes mecanismos de eructos excesivos. La actividad de los eructos supragastricos sigue un patrón distinto, caracterizado por un flujo rápido anterógrado y retrógrado de aire en el esófago que generalmente no llega al estómago. Este fenómeno de “eructos supragástricosâ€ no se acompaña de la relajación transitoria del esfínter esofágico inferior (EEI), como se observa en los eructos gástricos. Los eructos supragástricos se definen como una conducta en la que el aire eructado no se origina en el estómago, pero es succionado o inyectado en el esófago desde la faringe y expulsado inmediatamente después, por vía oral, en ausencia de una ingestión excesiva de aire. Los eructos son una manifestación frecuente de ERGE.', 'Mayores de 18 años con diagnostico de eructos supragastricos', 'Terapia cognitivo conductual y rehabilitacion en fonoaudiologica', 'De respuesta sintomática pre y post terapia cognitivo conductual y fonoaudiologica', '-Evaluar calidad de vida después de la terapia cognitiva conductual y fonoaudiologica', '1-Predictores de respuesta al tratamiento en pacientes con eructos supragastricos', '2-Impacto en el reflujo gastroesofagico\r\n3-Asociación con otros síntomas \r\n4-Síntomas iniciales ', 'ENSAYO CLINICO', 'EXPERIMENTAL', NULL, NULL, NULL, 'SIN PLACEBO', NULL, 'Pacientes mayores de 18 años de edad con diagnóstico de eructos supragastricos según los criterios de Roma IV', 'Aquellos pacientes que tengan diagnostico de un trastorno psiquiatrico.', 'Datos insuficientes.\r\nQue no complete el seguimiento.', 'Pacientes que consultan al Servicio de Gastroenterología, Sección Neurogastroenterología, por síntomas compatibles con eructos supragastricos, según los criterios de Roma IV', '', '', '', '', '', '', '', '', '', '', '', '', '', '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', '', '', '', '', '', '', '', NULL, '', '', '', '', '', '', '', '', '', NULL, 'si', '');
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(44, '35630511', '2021-04-15 13:52:32', '2021-04-15', 'si', 'Milagros', 'Celleri', '35630511', 'EXPERIMENTAL', 'Intervención cognitivo-conductual grupal en pacientes con trastornos  gastrointestinales funcionales', 'Celleri Milagros', '', '', 'Los trastornos gastrointestinales funcionales son un problema relevante en salud pública dado los costos económicos que generan, la complejidad en la comprensión de estos cuadros y el nivel de discapacidad que producen en la población afectada (Hungin, Whorwell,  Tack, & Mearin, 2003; Mahadeva & Goh, 2006). Siendo los cuadros funcionales los más prevalentes entre los trastornos gastrointestinales en general, dentro de estos cuadros, los de mayor prevalencia en la población son el síndrome de intestino irritable y la dispepsia funcional (Drossman, et al 1999). Los síntomas característicos relacionados con estos trastornos incluyen dolor abdominal, acidez, náuseas, constipación y diarrea (Haug, Mykletun & Dahl, 2002).\r\n\r\nActualmente aunque no se conoce un mecanismo fisiopatológico que explique estos cuadros, si se conocen distintos factores que influyen en su desarrollo y mantenimiento, y a diferencia de las explicaciones etiológicas previas, en la actualidad ha ido en aumento la evidencia científica acerca de la cercana relación entre el sistema nervioso central y las funciones gastrointestinales (Tobón, Vinaccia, & Sandín, 2003), y se considera recíproca la interacción entre lo fisiológico y lo psicosocial en el cuadro: el denominado eje cerebro-intestino (Drossman, et al 1999). \r\n\r\nEntre esos factores influyentes, los factores psicológicos ocupan un lugar relevante. \r\nEntre los factores psicológicos que influyen en el cuadro, se identifica la ansiedad, la depresión, el neuroticismo y una elevada somatización (Whitehead, Palsson, & Jones, 2002). Estos síntomas no solo son más prevalentes entre pacientes con trastornos funcionales en comparación con población control, sino también en comparación con pacientes con cuadros gastrointestinales orgánicos  (Haug, Mykletun & Dahl, 2002).La comorbilidad entre los trastornos gastrointestinales funcionales y los trastornos emocionales es elevada según se ha podido estudiar (Cruz, Ortiz, Muñiz, & Padiema, 2007). En estos pacientes en los que la sintomatología ansiosa y depresiva es elevada el tratamiento habitual suele no ser suficiente y presentarse de manera recurrente, además de no responder al tratamiento de forma adecuada, por lo que el abordaje psicológico es esencial (Haug, Mykletun, & Dahl, 2002; Jia, Jiang & Liu, 2017) \r\n\r\nFrente a esto, se ha resaltado la importancia del abordaje psicológico en conjunto con las intervenciones médicas, farmacológicas y nutricionales habituales, por ejemplo en intestino irritable una dieta baja en FODMAPS (Vila Rovira,et al 2016; Pérez, Torres-López & Zamarripa-Dorsey 2015; Chahuán, Uslar, Robles, Díaz, Antonio, & Hernández-Rocha 2016). El tratamiento psicológico de primera elección para el síndrome de intestino irritable es la terapia cognitivo-conductual (APA, 2019) y, en la dispepsia funcional también este tipo de terapia ha demostrado buenos resultados (Haag et al, 2007)\r\n\r\nEn la actualidad, en las intervenciones psicológicas contemporáneas de la terapia cognitivo conductual se apunta al proceso psicopatológico que sostienen los trastornos a diferencia de los abordajes basados en trastornos DSM específicos, permitiendo abordajes transdiagnósticos, haciendo énfasis más en las características compartidas de los trastornos, que en sus diferencias (Hofmann & Hayes 2019). Los trastornos emocionales comparten en común en su etiología una elevada afectividad negativa (neuroticismo), el cual se encuentra relacionado al estrés crónico, la hipervigilancia, percepción de incontrolabilidad y las conductas evitativas. Los distintos síntomas serían distintas expresiones de esta mismas dimensiones.\r\nEl rol de la regulación emocional en los trastornos emocionales desde esta perspectiva es central. Entendemos por regulación emocional a la capacidad de las personas de influir en su experiencia emocional (gross, cita). Las estrategias de regulación emocional desadaptativas serían las mantenedoras de los trastornos emocionales, como la rumiación o la evitación. Estrategias que paradójicamente, aumentan la expresión de la experiencia emocional. Existe evidencia de que los trastornos emocionales se caracterizan por intentos de regular (a través de intentos de control excesivos) la experiencia emocional \r\nTeniendo en cuenta esto, y la alta comorbilidad entre ansiedad y depresión (trastornos emocionales) que presentan los pacientes con trastornos gastrointestinales funcionales una intervención transdiagnóstica permitirá abordajes que incluyan pacientes con distintos diagnósticos dentro de cada espectro y un abordaje orientado al proceso común compartido, la desregulación emocional (Barlow, 2013).\r\n', 'Evaluar la efectividad de la intervención psicológica transdiagnóstica en la sintomatología\r\nansiosa y depresiva en pacientes con trastornos funcionales y su impacto en la calidad de\r\nvida y las molestias gastrointestinales.', 'Población:\r\nPacientes de entre 18 y 65 años que asisten al servicio de Neurogastroenterología del\r\nHospital de Clínicas, diagnosticados con algún trastorno gastrointestinal funcional\r\n(Dispepsia funcional o Síndrome de intestino irritable) según criterios Roma IV y algún\r\ntrastorno emocional (depresión o ansiedad) según criterios DSM 5.\r\nCriterios de inclusión\r\nDispepsia funcional o Síndrome de intestino irritable, en comorbilidad con trastornos\r\ndepresivos o ansiosos.\r\nCriterios de exclusión\r\nPresentar comorbilidad con algún trastorno psicótico, con algún tipo de trastorno bipolar o\r\ncon algún trastorno de personalidad.\r\nCriterios de eliminación\r\nSujetos que abandonen el tratamiento o se ausenten por más de 2 sesiones.', '', '', 'Los trastornos gastrointestinales funcionales son un problema relevante en salud pública dado los costos económicos que generan, la complejidad en la comprensión de estos cuadros y el nivel de discapacidad que producen en la población afectada (Hungin, Whorwell,  Tack, & Mearin, 2003; Mahadeva & Goh, 2006). Siendo los cuadros funcionales los más prevalentes entre los trastornos gastrointestinales en general, dentro de estos cuadros, los de mayor prevalencia en la población son el síndrome de intestino irritable y la dispepsia funcional (Drossman, et al 1999). Los síntomas característicos relacionados con estos trastornos incluyen dolor abdominal, acidez, náuseas, constipación y diarrea (Haug, Mykletun & Dahl, 2002).\r\n\r\nActualmente aunque no se conoce un mecanismo fisiopatológico que explique estos cuadros, si se conocen distintos factores que influyen en su desarrollo y mantenimiento, y a diferencia de las explicaciones etiológicas previas, en la actualidad ha ido en aumento la evidencia científica acerca de la cercana relación entre el sistema nervioso central y las funciones gastrointestinales (Tobón, Vinaccia, & Sandín, 2003), y se considera recíproca la interacción entre lo fisiológico y lo psicosocial en el cuadro: el denominado eje cerebro-intestino (Drossman, et al 1999). \r\n\r\nEntre esos factores influyentes, los factores psicológicos ocupan un lugar relevante. \r\nEntre los factores psicológicos que influyen en el cuadro, se identifica la ansiedad, la depresión, el neuroticismo y una elevada somatización (Whitehead, Palsson, & Jones, 2002). Estos síntomas no solo son más prevalentes entre pacientes con trastornos funcionales en comparación con población control, sino también en comparación con pacientes con cuadros gastrointestinales orgánicos  (Haug, Mykletun & Dahl, 2002).La comorbilidad entre los trastornos gastrointestinales funcionales y los trastornos emocionales es elevada según se ha podido estudiar (Cruz, Ortiz, Muñiz, & Padiema, 2007). En estos pacientes en los que la sintomatología ansiosa y depresiva es elevada el tratamiento habitual suele no ser suficiente y presentarse de manera recurrente, además de no responder al tratamiento de forma adecuada, por lo que el abordaje psicológico es esencial (Haug, Mykletun, & Dahl, 2002; Jia, Jiang & Liu, 2017) \r\n\r\nFrente a esto, se ha resaltado la importancia del abordaje psicológico en conjunto con las intervenciones médicas, farmacológicas y nutricionales habituales, por ejemplo en intestino irritable una dieta baja en FODMAPS (Vila Rovira,et al 2016; Pérez, Torres-López & Zamarripa-Dorsey 2015; Chahuán, Uslar, Robles, Díaz, Antonio, & Hernández-Rocha 2016). El tratamiento psicológico de primera elección para el síndrome de intestino irritable es la terapia cognitivo-conductual (APA, 2019) y, en la dispepsia funcional también este tipo de terapia ha demostrado buenos resultados (Haag et al, 2007)\r\n\r\nEn la actualidad, en las intervenciones psicológicas contemporáneas de la terapia cognitivo conductual se apunta al proceso psicopatológico que sostienen los trastornos a diferencia de los abordajes basados en trastornos DSM específicos, permitiendo abordajes transdiagnósticos, haciendo énfasis más en las características compartidas de los trastornos, que en sus diferencias (Hofmann & Hayes 2019). Los trastornos emocionales comparten en común en su etiología una elevada afectividad negativa (neuroticismo), el cual se encuentra relacionado al estrés crónico, la hipervigilancia, percepción de incontrolabilidad y las conductas evitativas. Los distintos síntomas serían distintas expresiones de esta mismas dimensiones.\r\nEl rol de la regulación emocional en los trastornos emocionales desde esta perspectiva es central. Entendemos por regulación emocional a la capacidad de las personas de influir en su experiencia emocional (gross, cita). Las estrategias de regulación emocional desadaptativas serían las mantenedoras de los trastornos emocionales, como la rumiación o la evitación. Estrategias que paradójicamente, aumentan la expresión de la experiencia emocional. Existe evidencia de que los trastornos emocionales se caracterizan por intentos de regular (a través de intentos de control excesivos) la experiencia emocional \r\nTeniendo en cuenta esto, y la alta comorbilidad entre ansiedad y depresión (trastornos emocionales) que presentan los pacientes con trastornos gastrointestinales funcionales una intervención transdiagnóstica permitirá abordajes que incluyan pacientes con distintos diagnósticos dentro de cada espectro y un abordaje orientado al proceso común compartido, la desregulación emocional (Barlow, 2013).\r\n', 'Pacientes de entre 18 y 65 años que asisten al servicio de neurogastroenterología del Hospital de Clínicas, diagnosticados con algún trastorno gastrointestinal funcional según criterios Roma IV y algún trastorno emocional (depresión o ansiedad) según criterios DSM 5.', 'Tratamiento cognitivo conductual basado en un modelo transdiagnóstico para ansiedad y depresión, en formato grupal, de 12 sesión de duración.', 'Pacientes en lista de espera.', 'Mejoria sintomatica estadísticamente significativa en comparación al grupo al inicio del\r\ntratamiento en las escalas de depresión (BDI II), ansiedad (BAI) y calidad de vida (MQLI:\r\nCalidad de vida) en comparacion con la lista de espera.', 'Evaluar la efectividad de la intervención psicológica transdiagnóstica en la sintomatología\r\nansiosa y depresiva en pacientes con trastornos funcionales y su impacto en la calidad de vida.', 'Evaluar procesos de cambio implicados en la aplicacion del Protocolo Unificado (regulación emocional, evitación experiencial y conciencia plena)', 'QUASI EXPERIMENTAL', 'EXPERIMENTAL', NULL, NULL, NULL, NULL, 'NO ALEATORIZADO', 'Dispepsia funcional o Síndrome de intestino irritable, en comorbilidad con trastornos depresivos o ansiosos.', 'Presentar comorbilidad con algún trastorno psicótico, con algún tipo de trastorno bipolar o con algún trastorno de personalidad. Riesgo de suicidio.', 'Sujetos que abandonen el tratamiento o se ausenten por más de 2 sesiones.', 'Pacientes de entre 18 y 65 años que asisten al servicio de Neurogastroenterología del Hospital de Clínicas, diagnosticados con algún trastorno gastrointestinal funcional (Dispepsia funcional o Síndrome de intestino irritable) según criterios Roma IV y algún trastorno emocional (depresión o ansiedad) según criterios DSM 5.', 'Protocolo de 10 sesiones, transdiagnóstico, basado en terapia cognitivo conductual\r\nadaptado a población Argentina.', 'Diferencias estadísticamente significativas entre las medidas tomadas en la sesión 1, 6 y 10\r\nde tratamiento. Se espera una mejoría estadísticamente significativa en los síntomas depresivos, ansiosos y somáticos de los pacientes.', 'Servicio de Neurogastroenterología del Hospital de Clínicas, intervención virtual dado el contexto de pandemia de junio a julio de 2021.', 'Mínimo 10 sujetos, máximo 12 sujetos en el grupo.', 'Se les tomará las siguientes escalas: \r\nBeck Anxiety Inventory (BAI) \r\nBeck Depression Inventory (BDI II)\r\nIndice multicultural de Calidad de Vida (MQLI), \r\nEscala Multidimensional de Evitación Experiencial (MEAQ)\r\n', 'Los pacientes serán reclutados a partir del servicio de neurogastroenterología del Hospital\r\nde Clínicas. Estos pacientes para ser incluidos en el grupo terapéutico deben cumplir\r\ncriterios para ser diagnosticados con algún trastorno gastrointestinal funcional (síndrome de\r\nintestino irritable, dispepsia funcional) según los criterios Roma IV. Ademas, deberan\r\ncumplir criterios para Trastornos depresivo mayor, trastorno por pánico, agorafobia,\r\ntrastorno de ansiedad generalizada o trastorno de ansiedad social según DSM 5.\r\nEl diagnóstico psicológico es realizado a partir de una entrevista clínica extensa entre el\r\npaciente y el profesional evaluador. Para ello, se utilizará la entrevista clínica diagnóstica\r\nSCID 5 en su versión web. Las entrevistas se llevarán a cabo por clínicos experimentados.\r\nLos criterios de exclusión de pacientes serán presentar comorbilidad con algún trastorno\r\npsicótico, con algún tipo de trastorno bipolar o con algún trastorno de personalidad.\r\nAdemás, se les tomará una escala de calidad de vida, y la escala de severidad de síndrome\r\nde intestino irritable. Los sujetos serán asignados aleatoriamente a dos condiciones de\r\ntratamiento: terapia grupal o lista de espera (reciben mientras tratamiento médico habitual).\r\nSe pedirá el consentimiento informado de los pacientes para la participación en la\r\ninvestigación. Se evaluará a los pacientes en la semana 1 de tratamiento, en la semana 6 y\r\nen la semana 10.', '', '', '', '', '', '', '', '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', '', '', '', '', '', '', '', NULL, '', 'Intervención cognitivo-conductual grupal en pacientes con trastornos\r\ngastrointestinales funcionales', '', '', '', '', '', '', '', NULL, 'si', 'American Psychological Association (2019). Diagnosis: irritable bowel syndrome, psychological treatments. \r\nChahuán, A., Uslar, N., Robles, G., Díaz, P., Antonio, L., & Hernández-Rocha, C. (2016). Una dieta baja en FODMAPs disminuye los síntomas del síndrome de intestino irritable. Gastroenterol. latinoam, 27(1), 62-65.\r\n\r\nDrossman, D. A., Creed, F. H., Olden, K. W., Svedlund, J., Toner, B. B., & Whitehead, W. E. (1999). Psychosocial aspects of the functional gastrointestinal disorders. Gut, 45(suppl 2), II25-II30.\r\n\r\nHaug, T. T., Mykletun, A., & Dahl, A. A. (2002). Are anxiety and depression related to gastrointestinal symptoms in the general population?. Scandinavian Journal of Gastroenterology, 37(3), 294-298.\r\n\r\n\r\nHaag, S., Senf, W., Tagay, S., Langkafel, M., Braunâ€Lang, U., Pietsch, A., ... & Holtmann, G. (2007). Is there a benefit from intensified medical and psychological interventions in patients with functional dyspepsia not responding to conventional therapy?. Alimentary pharmacology & therapeutics, 25(8), 973-986.\r\n\r\nHungin, A. P. S., Whorwell, P. J., Tack, J., & Mearin, F. (2003). The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects. Alimentary pharmacology & therapeutics, 17(5), 643-650.\r\n\r\nHofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7(1), 37-50.\r\n\r\nPérez, N., Torres-López, E., & Zamarripa-Dorsey, F. (2015). Respuesta clínica en pacientes mexicanos con síndrome de intestino irritable tratados con dieta baja en carbohidratos fermentables (FODMAP). Revista de Gastroenterología de México, 80(3), 180-185.\r\n\r\nVila Rovira, N., Ibáñez Solano, P., Angós Musgo, R. J., Betés Ibáñez, M. T., Carretero Ribón, C., De la Riva Onandía, S. R., ... & Margall Coscojuela, M. Ã. (2016). Pacientes con trastorno funcional intestinal: eficacia de una dieta baja en FODMAPS para el tratamiento de los síntomas digestivos. Nutr. clín. diet. hosp, 36(1), 64-74.\r\n\r\nTobón, S., Vinaccia, S., & Sandín, B. (2003). Tratamiento psicológico de la dispepsia funcional: un análisis crítico. Terapia psicológica, 21, 173-182.\r\n\r\nJia, L., Jiang, S. M., & Liu, J. (2017). Behavioral gastroenterology: An emerging system and new frontier of action. World journal of gastroenterology, 23(33), 6059.'),
(45, '24877346', '2021-08-20 02:24:57', NULL, 'si', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '', '', '', '', '', '', NULL, NULL, NULL),
(46, '31009954', '2022-04-22 18:12:47', '2022-04-22', 'si', '', '', '', 'OBSERVACIONAL', '“Utilidad Diagnóstica de la Calprotectina Fecal en la Diferenciación de Enfermedades Inflamatorias Intestinales y Síndrome de Intestino Irritable en Pacientes Adultos.  Estudio Descriptivo Multicéntrico en Argentinaâ', 'Uehara Tatiana', 'Piskorz MM., Linares M.E, Fuxman C., Bellicoso M., Litwin N.,Olmos J.', 'Olmos Jorge', 'La diferenciación entre el síndrome de intestino irritable (SII) y la enfermedad inflamatoria intestinal (EII) es compleja teniendo en cuenta que ambas enfermedades presentan síntomas similares, como la diarrea y el dolor abdominal principalmente. Pese a estas similitudes, ambas enfermedades presentan complicaciones, comorbilidades, pronósticos, tratamientos, que difieren considerablemente y por este motivo es fundamental su correcto diagnóstico.\r\nMuchas veces resulta difícil la diferenciación entre ambas enfermedades por lo que se recurre a la colonoscopía para la visualización directa de la mucosa y toma de biopsias ya que constituye un examen complementario fundamental para el diagnóstico de la EII. Pero es un método invasivo que resulta molesto, que no está libre de complicaciones, requiere preparación colónica, anestesia y tiene un costo relativamente alto. Algunos centros reportan hasta más de un 60% de colonoscopías normales que retrospectivamente podrían haberse evitado.\r\nLa calprotectina es una proteína que constituye aproximadamente el 60% de las proteínas solubles citoplasmáticas de los neutrófilos. Se encuentra elevada en la materia fecal reflejando la afluencia de granulocitos en la mucosa intestinal en situaciones en donde existe inflamación intestinal.  Ha sido estudiada ampliamente para correlacionar la actividad inflamatoria de la EII en relación con la actividad inflamatoria endoscópica e histológica e incluso puede predecir una recaída de la enfermedad.\r\nVarios estudios han valorado la utilidad de la calprotectina fecal para discriminar la EII y el SII siendo el valor de corte más frecuentemente utilizado de 50 µg/g. Sin embargo los estudios muestran diferentes puntos de corte en pacientes con SII.  Este punto es de fundamental importancia en la práctica clínica en paciente que no presentan sangrado como manifestación clínica, ya que un valor por encima del valor de corte indicaría la necesidad de realizar una colonoscopia para confirmar el diagnostico de EII. ', '1.	Evaluar la performance diagnostica de la calprotectina fecal (sensibilidad, especificidad, valores predictivos positivo y negativo) y determinar el mejor punto de corte para diferenciar el SII-D de EII.\r\n2.	Evaluar la performance diagnostica de la calprotectina fecal (sensibilidad, especificidad, valores predictivos positivo y negativo) y determinar el mejor punto de corte para diferenciar el SII-D de controles sanos\r\n\r\n3.	Correlacionar los niveles de calprotectina fecal y citoquinas pro y anti inflamatorias en pacientes son SII, EII y controles sanos\r\n', 'Diseño:\r\nEstudio observacional, prospectivo, de corte transversal.\r\n\r\nCriterios de inclusión: \r\nPacientes mayores a 18 años, que consultan al Servicio de Gastroenterología, Sección Neurogastroenterología, por síntomas compatibles con SII-D según los criterios de Roma IV, a los que se les haya descartado patología orgánica.\r\nPacientes mayores a 18 años que consultan al Servicio de Gastroenterología, consultorio de enfermedad inflamatoria intestinal y presentan diagnóstico reciente de EII y diarrea sin sangre evidente. Además, no tienen que haber recibido medicación como mesalazina, corticoides (sistémicos ni tópicos), inmunomoduladores, biológicos y/o pequeñas moléculas. Por otro lado, se incluirán pacientes con diagnóstico de EII y diarrea que hayan recibido medicación específica y que la hayan abandonado durante un mínimo de 12 semanas que presenten colonoscopía con actividad endoscópica (Mayo igual o mayor 1 o SES-CD igual o mayor a 4)\r\n\r\nControles sanos mayores a 18 años que sean personal de salud o administrativo del Hospital de Clínicas “José de San Martínâ€, así como también acompañantes de pacientes en seguimiento en gastroenterología que no presenten síntomas intestinales ni enfermedades previas.\r\n', '', '', 'La diferenciación entre el síndrome de intestino irritable (SII) y la enfermedad inflamatoria intestinal (EII) es compleja teniendo en cuenta que ambas enfermedades presentan síntomas similares, como la diarrea y el dolor abdominal principalmente. Pese a estas similitudes, ambas enfermedades presentan complicaciones, comorbilidades, pronósticos, tratamientos, que difieren considerablemente y por este motivo es fundamental su correcto diagnóstico.\r\nMuchas veces resulta difícil la diferenciación entre ambas enfermedades por lo que se recurre a la colonoscopía para la visualización directa de la mucosa y toma de biopsias ya que constituye un examen complementario fundamental para el diagnóstico de la EII. Pero es un método invasivo que resulta molesto, que no está libre de complicaciones, requiere preparación colónica, anestesia y tiene un costo relativamente alto. Algunos centros reportan hasta más de un 60% de colonoscopías normales que retrospectivamente podrían haberse evitado.\r\nLa calprotectina es una proteína que constituye aproximadamente el 60% de las proteínas solubles citoplasmáticas de los neutrófilos. Se encuentra elevada en la materia fecal reflejando la afluencia de granulocitos en la mucosa intestinal en situaciones en donde existe inflamación intestinal.  Ha sido estudiada ampliamente para correlacionar la actividad inflamatoria de la EII en relación con la actividad inflamatoria endoscópica e histológica e incluso puede predecir una recaída de la enfermedad.\r\nVarios estudios han valorado la utilidad de la calprotectina fecal para discriminar la EII y el SII siendo el valor de corte más frecuentemente utilizado de 50 µg/g. Sin embargo los estudios muestran diferentes puntos de corte en pacientes con SII.  Este punto es de fundamental importancia en la práctica clínica en paciente que no presentan sangrado como manifestación clínica, ya que un valor por encima del valor de corte indicaría la necesidad de realizar una colonoscopia para confirmar el diagnostico de EII. ', 'Pacientes mayores a 18 años, que consultan al Servicio de Gastroenterología, Sección Neurogastroenterología, por síntomas compatibles con SII-D según los criterios de Roma IV, a los que se les haya descartado patología orgánica.\r\nPacientes mayores a 18 años que consultan al Servicio de Gastroenterología, consultorio de enfermedad inflamatoria intestinal y presentan diagnóstico reciente de EII y diarrea sin sangre evidente. Además, no tienen que haber recibido medicación como mesalazina, corticoides (sistémicos ni tópicos), inmunomoduladores, biológicos y/o pequeñas moléculas. Por otro lado, se incluirán pacientes con diagnóstico de EII y diarrea que hayan recibido medicación específica y que la hayan abandonado durante un mínimo de 12 semanas que presenten colonoscopía con actividad endoscópica (Mayo igual o mayor 1 o SES-CD igual o mayor a 4)\r\n', 'Medición de calprotectina fecal y citoquinas pro y anti inflamatorias en sangre', '', 'Correlacionar los niveles de calprotectina fecal y citoquinas pro y anti inflamatorias en pacientes son SII, EII y controles sanos', '1.	Evaluar la performance diagnostica de la calprotectina fecal (sensibilidad, especificidad, valores predictivos positivo y negativo) y determinar el mejor punto de corte para diferenciar el SII-D de EII.', '2.	Evaluar la performance diagnostica de la calprotectina fecal (sensibilidad, especificidad, valores predictivos positivo y negativo) y determinar el mejor punto de corte para diferenciar el SII-D de controles sanos\r\n\r\n3.	Correlacionar los niveles de calprotectina fecal y citoquinas pro y anti inflamatorias en pacientes son SII, EII y controles sanos\r\n', NULL, 'OBSERVACIONAL', 'CORTE TRANSVERSAL', 'CON GRUPO CONTROL', NULL, NULL, NULL, 'Pacientes mayores a 18 años, que consultan al Servicio de Gastroenterología, Sección Neurogastroenterología, por síntomas compatibles con SII-D según los criterios de Roma IV, a los que se les haya descartado patología orgánica.\r\nPacientes mayores a 18 años que consultan al Servicio de Gastroenterología, consultorio de enfermedad inflamatoria intestinal y presentan diagnóstico reciente de EII y diarrea sin sangre evidente. Además, no tienen que haber recibido medicación como mesalazina, corticoides (sistémicos ni tópicos), inmunomoduladores, biológicos y/o pequeñas moléculas. Por otro lado, se incluirán pacientes con diagnóstico de EII y diarrea que hayan recibido medicación específica y que la hayan abandonado durante un mínimo de 12 semanas que presenten colonoscopía con actividad endoscópica (Mayo igual o mayor 1 o SES-CD igual o mayor a 4)\r\n\r\nControles sanos mayores a 18 años que sean personal de salud o administrativo del Hospital de Clínicas “José de San Martínâ€, así como también acompañantes de pacientes en seguimiento en gastroenterología que no presenten síntomas intestinales ni enfermedades previas.\r\n', 'De controles sanos y pacientes con SII\r\nFalta de firma del consentimiento informado.\r\nPresencia de patología orgánica por colonoscopía, definida como: colitis, ileítis, cáncer colorrectal, estenosis. No siendo considerados como enfermedad orgánica: diverticulosis, fisuras anales, adenomas o hemorroides.\r\nPresencia de patología orgánica por endoscopía digestiva alta, definida como: neoplasia, enfermedad inflamatoria intestinal, enfermedad celíaca.\r\nPacientes con antecedentes de:  adherencias intestinales previamente conocidas, enfermedades sistémicas tales como la enfermedad inflamatoria intestinal, enfermedad celíaca, enfermedades neoplásicas activas, insuficiencia cardíaca, renal o hepática severa, cirrosis, enolismo, consumo de sustancias de abuso, diabetes, demencia o déficit neurológico que impida la comprensión y el llenado del cuestionario y otras enfermedades reumatológicas, autoinmunes y tiroideas.\r\nQue haya recibido tratamiento antibiótico ni analgésicos no esteroideos en el último mes.\r\nDe pacientes con EII (Colitis Ulcerosa y Enfermedad de Crohn)\r\nFalta de firma del consentimiento informado\r\nPacientes con síntomas de alarma: hematoquezia, pérdida de peso, diarrea nocturna, anemia.\r\nPacientes con diagnóstico de EII que se encuentren en remisión clínica\r\nPacientes con diagnóstico de EII y actividad de la enfermedad en tratamiento con drogas específicas en las últimas 12 semanas.\r\nPacientes embarazadas\r\nPresencia de colitis infecciosas.\r\nPresencia de patología orgánica por colonoscopía como colitis actínica o de etiología infecciosa. No siendo considerados como enfermedad orgánica: diverticulosis, fisuras anales, adenomas o hemorroides.\r\nPresencia de patología orgánica por endoscopía digestiva alta como: neoplasia, enfermedad celíaca.\r\nPacientes con antecedentes de:  adherencias intestinales previamente conocidas, enfermedad celíaca, enfermedades neoplásicas activas, insuficiencia cardíaca, renal o hepática severa, cirrosis, enolismo, consumo de sustancias de abuso, diabetes, demencia o déficit neurológico que impida la comprensión y el llenado del cuestionario y otras enfermedades reumatológicas, autoinmunes y tiroideas.\r\n', 'Datos insuficientes.', 'Síndrome de intestino irritable: serán definidos como aquellos pacientes que presenten criterios de Roma IV y hayan sido evaluados por gastroenterólogos expertos (Anexo 1). Para evaluar el subtipo de SII según la predominancia de las características de las heces, se utilizará la escala de Bristol (Anexo 2) que es una tabla visual de uso en Medicina, destinada a clasificar la forma de heces las humanas en siete grupos.\r\n\r\nEnfermedad Inflamatoria Intestinal:  Serán definidos como aquellos pacientes que evaluados por un gastroenterólogo experto en EII, por hallazgos clínicos, endoscópicos e histológicos presenten diagnóstico de colitis ulcerosa o enfermedad de Crohn.\r\nControles sanos: aquellos que no tengas síntomas abdominales ni tengan patologías orgánicas al interrogatorio ni en el examen físico', 'Medición de calprotectina fecal y citoquinas pro y anti inflamatorias en sangre', 'Correlacionar los niveles de calprotectina fecal y citoquinas pro y anti inflamatorias en pacientes son SII, EII y controles sanos', 'Consultorios del Servicio de Gastroenterología, Sección Neurogastroenterología y consultorio de enfermedades inflamatorias intestinales del Hospital de Clínicas “José de San Martínâ€, Fundación Favaloro e Inmunología Buenos Aires desde el mes de abril del 2022 hasta abril del 2023.', 'Se estima evaluar en forma continua un número de 140 pacientes que consultan al Servicio de Gastroenterología, Sección Neurogastroenterología, por síntomas compatibles con SII-D según los criterios de Roma IV, a los que se les haya descartado patología orgánica, 30 pacientes con diagnóstico de colitis ulcerosa y enfermedad de Crohn leve a moderada que consultan a la sección de enfermedad inflamatoria y 70 controles sanos.', '\r\nEvaluación de calprotectina en materia fecal:\r\n\r\nSe determinará la concentración de CF mediante el kit de ELISA dela casa comercial Bühlmann (Basilea, Suiza) utilizando anticuerpo monoclonal contra la calprotectina. Las muestras se prepararán y analizarán de acuerdo con las instrucciones del fabricante en laboratorio Litwin.\r\nLa materia fecal deberá ser recolectada de una deposición al azar, no del inodoro o recipientes no controlado, sino en un film de polietileno nuevo y limpio, o en un recipiente plástico limpio tipo tupper lavado con agua corriente y dejado secar. El recipiente no debe contener restos de líquido, ni hipoclorito (lavandina). La muestra no deberá estar contaminada con orina.\r\nUna pequeña parte de la muestra, del tamaño de una cucharada sopera, se retira de film o recipiente con una cuchara o espátula, preferentemente plástica, y se coloca en un recipiente descartable seco sin ningún tipo de líquido, del tipo de orina para urocultivo, cerrado a rosca hermético.\r\nLa muestra deberá ser remitida por el paciente preferentemente de inmediato, o en su defecto en el día, conservada en heladera hasta su remisión.\r\nLa muestra puede ser conservada en heladera por el Servicio Médico hasta 96 horas de recibida, conservada en heladera entre 2 y 8 grados centígrados.\r\nDeberá ser remitida al laboratorio en recipiente o caja tipo tergopol cerrado con cinta adhesiva plástica, en posición con tapa arriba para evitar derrames internos y pérdidas de material. El traslado debrá respetar la cadena de frío, con conservantes plásticos, no hielo.\r\nCada recipiente remitido debe estar rotulado con etiqueta autoadhesiva en forma inequívoca, con el número de estudio que debe coincidir con el de la planilla adjunta, el nombre y apellido del paciente y la fecha en que el Servicio Médico recibió la muestra.\r\nTodos los datos deben coincidir con la planilla que debe acompañar el envío. No se procesarán muestras con datos faltantes o ilegibles, no coincidencias entre el número de estudio y los datos del paciente o en malas condiciones de remisión o conservación o sin seguridad biológica (muestras destapadas o volcadas o frascos rotos, etc).\r\n\r\nEvaluación de citoquinas en sangre:\r\nSe analizará un panel de 27 citoquinas en muestras de suero. Así, IL-1B, IL-1ra, L-2, IL-3, IL-4, IL-5, IL-6, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, FGF básico, Eotaxina, G-CSF, GM-CSF, IFN gamma, IP-10, MCP-1, MIP 1 alfa, MIP 1 beta, PDGF-BB, RANTES, TNF alfa, VEGF fueron cuantificados con el kit comercial Bio-Plex Pro™ï¸ Human Cytokine 27-plex. Los ensayos se llevaron a cabo de acuerdo con las instrucciones del fabricante (Bio Rad, EE. UU.).\r\nSe obtendrán muestras de sangre venosa periférica de los participantes en el estudio en ayunas al menos 12 h después de la última comida, en tubos de extracción de sangre BD Vacutainer, cod. 367983 con activador de coágulos, gel de polímero. Después de dejar que se coagule durante al menos 30 minutos, pero no más de 120 min, las muestras se centrifugarán a 3000 g durante 10 minutos. El suero se pipeteará en viales Eppendorf de 1,5 mL y se congelarán (-80 °C) hasta su análisis.\r\n', '1.	Obtención del consentimiento informado de todos los participantes. (Anexo 11)\r\n2.	A todos los participantes se les realizará la historia clínica y confección un formulario de variables clínicas (Anexo 10): edad, sexo, ocupación, estado civil, nivel educacional, peso, comorbilidades, síntomas por los cuales consulta, examen físico, se evaluarán estudios realizados.\r\n\r\n3.	 A los pacientes que tengan SII-D se le solicitará al paciente que refiera las características de las deposiciones mediante la Escala de Bristol, que realice la puntuación global de los síntomas que presentó en los últimos 7 días previos al inicio del estudio a través de la Escala de Likert y que confeccione las escalas de ansiedad y depresión, de somatización, severidad del SII y estrés.\r\n\r\n4.	En los pacientes con EII se evaluará el número de deposiciones por día, valoración global por un médico especialista, hallazgos endoscópicos y de laboratorio. \r\n\r\n\r\n5.	Las medición de la calprotectina fecal serán realizadas en el laboratorio Litwin.\r\n', 'El análisis de los datos se realizará con el paquete estadístico STATA ®v. 17.0.\r\nAsumiremos una diferencia estadísticamente significativa con una p < 0,05.\r\nLas variables categóricas cuyos resultados estaban expresados en porcentuales serán analizados con el Test de Chi cuadrado. Las variables continuas serán analizadas con test de T (paramétrico) o test de Wilcoxon (no paramétrico) según el comportamiento de la variable.\r\n El análisis de correlación entre los índices de actividad inflamatoria en EII (índice de mayo y SES-CD) y variables seleccionadas se realizarán mediante el test de correlación de Pearson o Spearman según el comportamiento de las variables. El análisis de las curvas ROC (reciever operating characteristic) será utilizada para determinar el área bajo la curva y punto de corte apropiado para la calprotectina fecal como predictor de ausencia de inflamación. De acuerdo con el punto de corte apropiado se evaluará la sensibilidad, especificidad y valores predictivos con intervalo de confianza del 95%.\r\n', 'si', 'si', 'si', '', '', '', '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', 'UEHARA TATIANA NOEMI', 'UTILIDAD DIAGNÓSTICA DE LA CALPROTECTINA FECAL EN LA DIFERENCIACIÓN DE ENFERMEDADES INFLAMATORIAS INTESTINALES Y SÃNDROME DE INTESTINO IRRITABLE EN PACIENTES ADULTOS.\r\nESTUDIO DESCRIPTIVO MULTICÉNTRICO EN ARGENTINA\r\n', 'OBSERVACIONAL, PROSPECTIVO, DE CORTE TRANSVERSAL', 'SECTOR NEUROGASTROENTEROLOGÃA HOSPITAL DE CLINICAS JOSÉ DE SAN MARTÃN', 'DR. JORGE OLMOS/ DR. ESTEBAN GONZÃLEZ BALLERGA', 'UEHARA TATAIANA NOEMI', '', 'si', '1.	¿Qué es un estudio observacional?\r\nEs un estudio en dónde el objetivo es la observación y registro de mediciones que se realizan en un tiempo determinado.\r\n', '“Utilidad Diagnóstica de la Calprotectina Fecal en la Diferenciación de Enfermedades Inflamatorias Intestinales y Síndrome de Intestino Irritable en Pacientes Adultos.\r\n Estudio Descriptivo Multicéntrico en Argentinaâ€\r\n', 'Se quiere realizar con el objetivo de evaluar el punto de corte de la calprotectina fecal', 'Se le propone participar del estudio porque usted padece de síndrome de intestino irritable subtipo diarrea o enfermedad inflamatoria intestinal o es un control sano', 'Podría no haber beneficios para usted en este estudio, pero si para otros pacientes. ', 'Disponer en la práctica clínica de mayor evidencia para el diagnóstico  del síndrome de intestino irritable', 'Se realizarán estudios de laboratorio y endoscopías si corresponde por la edad y síntomas y tomar una muestra de materia fecal en un frasco estéril que deberá ser entregado en Consultorios del Servicio de Gastroenterología, Sección Neurogastroenterología y consultorio de enfermedades inflamatorias intestinales del Hospital de Clínicas “José de San Martínâ€ 4to piso sala 2 de 8 a 12hs de lunes a viernes', 'En la consulta inicial deberá completar un formulario de síntomas gastrointestinales, un estudio de laboratorio y endoscopías si corresponde por la edad y/o síntomas. Y deberá entregar una muestra de materia fecal en un frasco estéril que deberá recolectar en su domicilio.', 'Usted tendrá derecho a retirarse del estudio en cualquiera de las instancias, sin tener que dar ninguna explicación. Durante el estudio tendrá a su disposición el teléfono del médico tratante para despejar dudas o inquietudes.', NULL, 'si', '1_ Porter et al. Risk of inflammatory bowel disease following a diagnosis of irritable bowel syndrome  BMC Gastroenterology 2012, 12:55\r\n2_N. Waugh, E. Cummins, P. Royle et al., “Faecal calprotectin\r\ntesting for differentiating amongst inflammatory and noninflammatory bowel diseases: systematic review and economic\r\nevaluation,â€ Health Technology Assessment, vol. 17, no. 55, pp. 1–\r\n211, 2013.\r\n3_Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-721.e4. doi: 10.1016/j.cgh.2012.02.029. Epub 2012 Mar 15.\r\n4_ J.A.Olmos,G.Iantorno. Irritable bowel syndrome: prevalence, comorbidity and impact: a population based study. UEGW 2010.\r\n5_Agarwal N, Spiegel BM. The effect of irritable bowel syndrome on health-related quality of life and health care expenditures. Gastroenterol Clin North Am. 2011 Mar;40(1):11-9. doi: 10.1016/j.gtc.2010.12.013.\r\n6_El-Serag HB, Pilgrim P, Schoenfeld P. Systemic Review: Natural history of irritable bowel syndrome. Aliment Pharmacol Ther. 2004 Apr 15;19(8):861-70.\r\n7_Brian E. Lacy,1 Fermín Mearin, et al.Bowel Disorders.Gastroenterology 2016;150:1393–1407.\r\n8_ Chey W, Nojkov B, Rubenstein J, et al. The yield of colonoscopy in patients\r\nwith non-constipated irritable bowel syndrome: results from a prospective, controlled US trial. Am J Gastroenterol 2010; 105: 859–65.\r\n9_ Cash B, Schoenfeld P, Chey W. The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review. Am J Gastroenterol 2002; 97: 2812–9.\r\n10_Rosa LS Soares.Irritable bowel syndrome: A clinical review.World J Gastroenterol 2014 September 14; 20(34): 12144-12160.\r\n11_ Michael Camilleri, M.D. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med 2012; 367:1626-1635 October 25, 2012. DOI: 10.1056/NEJMra1207068.\r\n12_ Michael Camilleri, Karen Lasch and Wen Zhou. Irritable Bowel Syndrome: Methods, Mechanisms, and Pathophysiology. The confluence of increased síndrome permeability, inflammation, and pain in irritable bowel. Am J Physiol Gastrointest Liver Physiol 303:G775-G785, 2012. First published 26 July 2012; doi: 10.1152/ajpgi.00155.2012.\r\n13_Joseph D. Feuerstein, Adam S. Cheifetz,.Ulcerative Colitis: Epidemiology, Diagnosis, and Management. Mayo Clin Proc. 2014;89(11):1553-1563\r\n14_Francis Ha, Hanan Khalil. Crohn’s disease: a clinical update. Ther Adv Gastroenterol2015, Vol. 8(6) 352–359\r\n15_ Poullis A, Foster R, et al. Review article: faecal markers in the assessment of activity in infammatory bowel disease. Aliment Pharmacol Ther 2002; 16: 675±681.\r\n16_Kawashima K, Ishihara S, Yuki T, et al. Fecal calprotectin more accurately\r\npredicts endoscopic remission of Crohnʼs disease than serological\r\nbiomarkers evaluated using balloon-assisted enteroscopy. Inflamm Bowel Dis\r\n2017;23:2027–34.\r\n17_Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjarnason I.\r\nSurrogate markers of intestinal in¯ammation are predictive of\r\nrelapse in patients with in¯ammatory bowel disease. Gastroenterology\r\n2000; 119(1): 15±22.\r\n\r\n18_Lasson A, Stotzer PO, Öhman L, et al. The intra-individual variability of\r\nfaecal calprotectin: a prospective study in patients with active ulcerative\r\ncolitis. J Crohns Colitis. 2015;9:26–32.\r\n19_Menees S , Powell C , Kurlander J et al. A meta-analysis of the utility of\r\nC-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and\r\nfecal lactoferrin to exclude infl ammatory bowel disease in adults with IBS .\r\nAm J Gastroenterol 2015 ; 110 : 444 – 54.\r\n20_Lozoya Angulo ME, De las Heras Gómez I, Martinez Villanueva M, Noguera\r\nVelasco JA, Avilés PLaza F. Calprotectina fecal, marcador eficaz en la\r\ndiferenciación de enfermedades inflamatorias intestinales y trastornos\r\nfuncionales gastrointestinales. Gastroenterol Hepatol. 2017;40(3):125–31.\r\n'),
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(50, '33862581', '2022-07-21 04:11:16', '', 'si', 'Jesica', 'Andruetto', '33862581', 'OBSERVACIONAL', '', '', '', '', 'La Enfermedad por Reflujo Gastroesofágico (ERGE)  constituye una de las entidades del tracto digestivo de mayor prevalencia en nuestra población y se define ,de acuerdo al consenso de Lyon,como los síntomas o las complicaciones resultantes del reflujo del contenido gástrico hacia el esófago, la cavidad oral (incluida la laringe) o los pulmones 1\r\nLa prevalencia mundial estimada de la ERGE se encuentra entre el 8 % y el 33 % para todos los grupos de edad y ambos sexos. La prevalencia también varía sustancialmente entre países, afectando principalmente a poblaciones en países occidentales, incluidos América, Europa, Australia-Nueva Zelanda y Medio Oriente (10% a 30%). Es menos común en el este de Asia (<10%), y no hay datos disponibles para Ãfrica 2-3.\r\n.En Latinoamérica se carece de estudios epidemiológicos fiables con una notable variabilidad que nos permitan conocer la verdadera prevalencia de la ERGE.Un estudio realizado en la Argentina reportó un 23% de prevalencia de síntomas típicos de ERGE (pirosis, regurgitación) frecuentes (al menos una vez por semana). 4\r\nEsta dificultad para disponer de datos epidemiológicos fiables estriba tanto en la ausencia de un patrón oro que permita confirmar o descartar con seguridad la existencia de ERGE como en la gran variabilidad clínica con que puede presentarse esta entidad (ERGE con esofagitis, ERGE sin esofagitis, pirosis funcional, etc.).5\r\nLos síntomas son varios e incluyen la pirosis y  la  regurgitación  (síntomas  esofágicos  típicos),  el  dolor  torácico  no  cardiogénico  (DTNC)  y  algunos  síntomas  extraesofágicos como la tos, la disfonía , el carraspeo y el globo faríngeo.Por otro lado, existen algunos confundidores  de  la  ERGE,  como  los  eructos  supragástricos  y  el síndrome de rumiación.6\r\n\r\nCon respecto a los métodos diagnósticos, cuando los síntomas putativos de ERGE no responden a la terapia empírica con IBP, se recomienda realizar una endoscopia digestiva alta (VEDA) que incluya la inspección de esofagitis erosiva (de acuerdo con la clasificación LA), el hiato diafragmático (grado de Hill), la longitud de la hernia de hiato axial y la inspección del esófago de Barrett (clasificación de acuerdo a Praga) y biopsia cuando esté presente. En resumen, hasta el 80% de los pacientes sintomáticos no tendrán evidencia objetiva de reflujo en la endoscopia, tiene una baja sensibilidad en el diagnóstico.10\r\nLa monitorización de la impedancia intraluminal multicanal esofágica y monitorización del pH (MII-pH) de 24 horas se considera el estándar de oro para la evaluación de la enfermedad por reflujo gastroesofágico (ERGE).Es el único test que permite identificar la presencia de exposición ácida anormal del esófago, tipo de reflujo (ácido, no ácido [NAR]) y la asociación entre los síntomas y los episodios de reflujo con una sensibilidad 77-100% y especificidad del 85-100% en pacientes con esofagitis erosiva. El monitoreo permite diferenciar los distintos fenotipos (ERGE, esófago hipersensible, pirosis funcional).11,12\r\nEl análisis de los trazados de MII-PH requiere mucho más tiempo porque necesita una revisión manual del trazado después del análisis automático.El análisis automático sobreestima particularmente el número de eventos de reflujo no ácido, lo que resulta en una menor sensibilidad y especificidad de un índice de síntomas positivos (SI) en comparación con el análisis visual.El análisis visual del registro de impedancia requiere experiencia. 13.\r\nEn cuanto a las limitaciones relacionadas con el análisis, el primer aspecto a considerar es que el software de análisis automático no es suficientemente fiable y generalmente sobreestima el número de eventos de reflujo no-ácido . Es por tanto imprescindible el análisis visual adicional realizado por personal con experiencia para evitar falsos-positivos, lo que inevitablemente conlleva un componente subjetivo (19) y aumento de costes.13-15\r\n \r\nEn el año 2006, Roman y col. realizaron un estudio que tuvo el objetivo de evaluar la eficiencia del análisis automático para el diagnóstico de ERGE en comparación con el análisis manual.  Setenta y tres pacientes  con síntomas sugestivos de ERGE remitidos para pruebas esofágicas se sometieron a monitorización ambulatoria de impedanciometría- pH de 24 h en cinco centros académicos franceses. El análisis de las grabaciones se realizó de forma visual (V) y automáticamente utilizando la función Auto Scan (AS) del software Bioview. El análisis AS detectó más eventos de reflujo, especialmente eventos no ácidos, líquidos, de gas puro y proximales. La detección de eventos de exposición al ácido esofágico y reflujo ácido fue similar con ambos análisis. La concordancia entre el análisis V y AS fue buena (Kendall\' coeficiente s W > 0,752 a 0,989, P < 0,01) para todos los parámetros. Durante los estudios de impedanciometría-pH, 65 pacientes informaron síntomas. En comparación con el análisis visual, la sensibilidad y la especificidad de un IS positivo determinado por AS fueron respectivamente 85,7 % y 80 % para todos los eventos de reflujo, 100 % y 98 % para reflujo ácido y 33 % y 87,5 % para reflujo no ácido. A pesar de la buena concordancia con el análisis visual, el análisis automático sobreestimó el número de eventos de reflujo no ácido. 16\r\nUn estudio realizado por K.Ravi y col.en el año 2010 en la Mayo Clinic de EE.UU,  tuvo el objetivo de evaluar la concordancia entre observadores para impedanciometría-pH con respecto el Autoscan.  Se seleccionaron al azar veinte estudios impedanciometría-pH  en pacientes que tomaban un IBP dos veces al día. Autoscan™ analizó todos los estudios utilizando los mismos parámetros preprogramados. Cuatro revisores interpretaron los estudios impedanciometría-pH, agregando o eliminando episodios de reflujo detectados por AutoscanTM.La concordancia entre observadores entre los revisores y Auto Scan™ para detectar NAR patológica es moderada.\r\nMouhamed Amr Saboun  y col.  Evaluaron la confiabilidad de 2 tipos diferentes de software de análisis MII-pH de 24 horas en comparación con la interpretación proporcionada por un experto. Hicieron una revisión retrospectiva de 200 MII-pH consecutivos estudios sobre terapia con IBP una o dos veces al día (65% mujeres, edad media 48,6 años). 100 fueron hechos usando equipo Sandhill y software reciente (Bioview análisis versión 5.5.4.1) y 100 realizado con equipo MMS y software reciente (MMS versión V 8.19h). Todos los estudios realizados entre el 09/2009 y el 9/2014. Todos los trazados fueron interpretados por el mismo experto. con una experiencia de haber leído más de 1500 estudios MII-pH. Los datos indicaron una fuerte correlación entre el análisis del experto y ambos softwares automáticos en todas las posiciones, la puntuación de Demeester, los episodios de reflujo y el índice de síntomas (p<0,0001). Para los estudios interpretados como normales o anormales, hubo concordancia entre el análisis experto y el software el 95 % de las veces para el software MMS y el 93 % de las instancias para el software Sandhill. Este estudio demostró una fuerte correlación entre la interpretación proporcionada por un experto y el análisis automático del software para 24 horas MII-pH Sin embargo, no hay un acuerdo total por lo que  recomienda que el médico intérprete mira los trazados antes de firmar el informe para detectar posibles problemas, como mal funcionamiento de la sonda.\r\n', '', '', '', '', 'La Enfermedad por Reflujo Gastroesofágico (ERGE)  constituye una de las entidades del tracto digestivo de mayor prevalencia en nuestra población y se define ,de acuerdo al consenso de Lyon,como los síntomas o las complicaciones resultantes del reflujo del contenido gástrico hacia el esófago, la cavidad oral (incluida la laringe) o los pulmones 1\r\nLa prevalencia mundial estimada de la ERGE se encuentra entre el 8 % y el 33 % para todos los grupos de edad y ambos sexos. La prevalencia también varía sustancialmente entre países, afectando principalmente a poblaciones en países occidentales, incluidos América, Europa, Australia-Nueva Zelanda y Medio Oriente (10% a 30%). Es menos común en el este de Asia (<10%), y no hay datos disponibles para Ãfrica 2-3.\r\n.En Latinoamérica se carece de estudios epidemiológicos fiables con una notable variabilidad que nos permitan conocer la verdadera prevalencia de la ERGE.Un estudio realizado en la Argentina reportó un 23% de prevalencia de síntomas típicos de ERGE (pirosis, regurgitación) frecuentes (al menos una vez por semana). 4\r\nEsta dificultad para disponer de datos epidemiológicos fiables estriba tanto en la ausencia de un patrón oro que permita confirmar o descartar con seguridad la existencia de ERGE como en la gran variabilidad clínica con que puede presentarse esta entidad (ERGE con esofagitis, ERGE sin esofagitis, pirosis funcional, etc.).5\r\nLos síntomas son varios e incluyen la pirosis y  la  regurgitación  (síntomas  esofágicos  típicos),  el  dolor  torácico  no  cardiogénico  (DTNC)  y  algunos  síntomas  extraesofágicos como la tos, la disfonía , el carraspeo y el globo faríngeo.Por otro lado, existen algunos confundidores  de  la  ERGE,  como  los  eructos  supragástricos  y  el síndrome de rumiación.6\r\n\r\nCon respecto a los métodos diagnósticos, cuando los síntomas putativos de ERGE no responden a la terapia empírica con IBP, se recomienda realizar una endoscopia digestiva alta (VEDA) que incluya la inspección de esofagitis erosiva (de acuerdo con la clasificación LA), el hiato diafragmático (grado de Hill), la longitud de la hernia de hiato axial y la inspección del esófago de Barrett (clasificación de acuerdo a Praga) y biopsia cuando esté presente. En resumen, hasta el 80% de los pacientes sintomáticos no tendrán evidencia objetiva de reflujo en la endoscopia, tiene una baja sensibilidad en el diagnóstico.10\r\nLa monitorización de la impedancia intraluminal multicanal esofágica y monitorización del pH (MII-pH) de 24 horas se considera el estándar de oro para la evaluación de la enfermedad por reflujo gastroesofágico (ERGE).Es el único test que permite identificar la presencia de exposición ácida anormal del esófago, tipo de reflujo (ácido, no ácido [NAR]) y la asociación entre los síntomas y los episodios de reflujo con una sensibilidad 77-100% y especificidad del 85-100% en pacientes con esofagitis erosiva. El monitoreo permite diferenciar los distintos fenotipos (ERGE, esófago hipersensible, pirosis funcional).11,12\r\nEl análisis de los trazados de MII-PH requiere mucho más tiempo porque necesita una revisión manual del trazado después del análisis automático.El análisis automático sobreestima particularmente el número de eventos de reflujo no ácido, lo que resulta en una menor sensibilidad y especificidad de un índice de síntomas positivos (SI) en comparación con el análisis visual.El análisis visual del registro de impedancia requiere experiencia. 13.\r\nEn cuanto a las limitaciones relacionadas con el análisis, el primer aspecto a considerar es que el software de análisis automático no es suficientemente fiable y generalmente sobreestima el número de eventos de reflujo no-ácido . Es por tanto imprescindible el análisis visual adicional realizado por personal con experiencia para evitar falsos-positivos, lo que inevitablemente conlleva un componente subjetivo (19) y aumento de costes.13-15\r\n \r\nEn el año 2006, Roman y col. realizaron un estudio que tuvo el objetivo de evaluar la eficiencia del análisis automático para el diagnóstico de ERGE en comparación con el análisis manual.  Setenta y tres pacientes  con síntomas sugestivos de ERGE remitidos para pruebas esofágicas se sometieron a monitorización ambulatoria de impedanciometría- pH de 24 h en cinco centros académicos franceses. El análisis de las grabaciones se realizó de forma visual (V) y automáticamente utilizando la función Auto Scan (AS) del software Bioview. El análisis AS detectó más eventos de reflujo, especialmente eventos no ácidos, líquidos, de gas puro y proximales. La detección de eventos de exposición al ácido esofágico y reflujo ácido fue similar con ambos análisis. La concordancia entre el análisis V y AS fue buena (Kendall\' coeficiente s W > 0,752 a 0,989, P < 0,01) para todos los parámetros. Durante los estudios de impedanciometría-pH, 65 pacientes informaron síntomas. En comparación con el análisis visual, la sensibilidad y la especificidad de un IS positivo determinado por AS fueron respectivamente 85,7 % y 80 % para todos los eventos de reflujo, 100 % y 98 % para reflujo ácido y 33 % y 87,5 % para reflujo no ácido. A pesar de la buena concordancia con el análisis visual, el análisis automático sobreestimó el número de eventos de reflujo no ácido. 16\r\nUn estudio realizado por K.Ravi y col.en el año 2010 en la Mayo Clinic de EE.UU,  tuvo el objetivo de evaluar la concordancia entre observadores para impedanciometría-pH con respecto el Autoscan.  Se seleccionaron al azar veinte estudios impedanciometría-pH  en pacientes que tomaban un IBP dos veces al día. Autoscan™ analizó todos los estudios utilizando los mismos parámetros preprogramados. Cuatro revisores interpretaron los estudios impedanciometría-pH, agregando o eliminando episodios de reflujo detectados por AutoscanTM.La concordancia entre observadores entre los revisores y Auto Scan™ para detectar NAR patológica es moderada.\r\nMouhamed Amr Saboun  y col.  Evaluaron la confiabilidad de 2 tipos diferentes de software de análisis MII-pH de 24 horas en comparación con la interpretación proporcionada por un experto. Hicieron una revisión retrospectiva de 200 MII-pH consecutivos estudios sobre terapia con IBP una o dos veces al día (65% mujeres, edad media 48,6 años). 100 fueron hechos usando equipo Sandhill y software reciente (Bioview análisis versión 5.5.4.1) y 100 realizado con equipo MMS y software reciente (MMS versión V 8.19h). Todos los estudios realizados entre el 09/2009 y el 9/2014. Todos los trazados fueron interpretados por el mismo experto. con una experiencia de haber leído más de 1500 estudios MII-pH. Los datos indicaron una fuerte correlación entre el análisis del experto y ambos softwares automáticos en todas las posiciones, la puntuación de Demeester, los episodios de reflujo y el índice de síntomas (p<0,0001). Para los estudios interpretados como normales o anormales, hubo concordancia entre el análisis experto y el software el 95 % de las veces para el software MMS y el 93 % de las instancias para el software Sandhill. Este estudio demostró una fuerte correlación entre la interpretación proporcionada por un experto y el análisis automático del software para 24 horas MII-pH Sin embargo, no hay un acuerdo total por lo que  recomienda que el médico intérprete mira los trazados antes de firmar el informe para detectar posibles problemas, como mal funcionamiento de la sonda.\r\n', '', '', '', '', 'Evaluar si existe variabilidad significativa de interpretaciones entre el análisis del Autoscan y el realizado por el observador.', '', NULL, 'OBSERVACIONAL', NULL, 'DESCRIPTIVO', NULL, NULL, NULL, '', '', '', '', '', '', '', '', '', '', '', '', '', '', '', '', '', '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', NULL, '', '', '', '', '', '', '', '', NULL, '', '', '', '', '', '', '', '', '', NULL, 'si', ''),
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-- --------------------------------------------------------

--
-- Estructura de tabla para la tabla `psico`
--

CREATE TABLE `psico` (
  `id` int(22) NOT NULL,
  `pac` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `date` varchar(22) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `usr` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `dateMod` varchar(22) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `fechaEstu` varchar(22) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `mqli` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `bdi` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `staiEstado` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `staiRasgo` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `scl90` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `ipq` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `idPsi` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `anteFa` text COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `antePsi` text COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `tAnsie` varchar(2) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `tept` varchar(2) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `toc` varchar(2) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `tDepre` varchar(2) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `tBipo` varchar(2) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `tPerso` varchar(2) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `tPsi` varchar(11) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `ansie` varchar(22) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `depre` varchar(22) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `PHQ15` varchar(22) COLLATE utf8mb4_unicode_ci DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Volcado de datos para la tabla `psico`
--

INSERT INTO `psico` (`id`, `pac`, `date`, `usr`, `dateMod`, `fechaEstu`, `mqli`, `bdi`, `staiEstado`, `staiRasgo`, `scl90`, `ipq`, `idPsi`, `anteFa`, `antePsi`, `tAnsie`, `tept`, `toc`, `tDepre`, `tBipo`, `tPerso`, `tPsi`, `ansie`, `depre`, `PHQ15`) VALUES
(8, '2949', '2019-07-10 13:38:39', '35630511', '2019-07-17 13:23:51', '2019-07-10', '', '', '', '', '', '', '', '', '', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(11, '2949', '2019-07-17 13:19:05', '35630511', '2019-07-17 13:19:16', '2019-07-17', '41', '39', '62', '65', '', '', '001', 'Hipertension hemocromatosis', 'Tio esquizofrenia', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(12, '208', '2019-07-17 13:22:18', '35630511', '2019-07-17 13:22:27', '2019-07-17', '51', '12', '41', '46', '', '', '002', '', '', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(13, '3376', '2019-07-17 13:24:44', '35630511', '2019-07-17 13:24:53', '2019-07-17', '37', '25', '49', '58', '', '', '003', 'Intento de suicidio madre, y dos hermanos', '', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(14, '2656', '2019-07-17 13:26:54', '35630511', '2019-07-17 13:49:08', '2019-07-17', '87', '6', '31', '33', '', '', '005', '', '', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(15, '35', '2019-07-17 13:28:53', '35630511', '2019-07-17 13:29:00', '2019-07-17', '66', '', '47', '48', '', '', '004', 'Madre depresion', '', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(16, '2656', '2019-07-17 13:48:42', '35630511', NULL, '2019-07-17', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(17, '2698', '2019-07-24 12:39:15', '35630511', '2019-07-24 13:06:24', '2019-07-24', '50', '27', '52', '54', '0', '0', '007', 'Hijo tumor muñeca\r\nHija epilepsia\r\n', 'Ninguno. Ella consulto por nervios. Ella toma sertralina y clonazepam', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(18, '2882', '2019-07-24 13:46:30', '35630511', '2019-07-24 13:46:35', '2019-07-24', '64', '0', '0', '0', '0', '0', '009', '- \r\nSUYO: NO', 'FAMILIAR: \r\nHNO ESQUIZOFRENIA \r\nSUYO: NO', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(19, '3668', '2019-07-31 14:28:02', '95229496', NULL, '2019-07-31', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(21, '3982', '2020-10-12 18:55:05', '34648880', NULL, '2020-10-12', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(22, '3982', '2020-10-12 18:56:03', '34648880', NULL, '2020-10-12', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(23, '2882', '2020-11-10 04:07:30', '34296749', NULL, '2020-11-10', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(24, '35', '2020-11-10 04:09:15', '34296749', NULL, '2020-11-10', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(25, '3982', '2020-11-10 04:11:19', '34296749', NULL, '2020-11-10', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(26, '2698', '2020-11-10 04:12:24', '34296749', NULL, '2020-11-10', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(27, '3376', '2020-11-10 04:13:10', '34296749', NULL, '2020-11-10', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(28, '3668', '2020-11-10 04:13:47', '34296749', NULL, '2020-11-10', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(29, '208', '2020-11-10 04:39:17', '34296749', NULL, '2020-11-10', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(30, '4145', '2020-11-19 13:29:29', '34296749', '2020-11-19 13:29:41', '2020-11-19', '', '', '', '', '', '', '', '', '', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', ''),
(31, '4145', '2020-12-30 17:57:33', '34296749', NULL, '2020-12-30', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(32, '5461', '2021-05-03 15:38:17', '25744623', NULL, '2021-05-03', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(33, '', '2021-05-27 14:03:00', '322', NULL, '2021-05-27', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(34, '857', '2021-08-10 22:55:11', '35360093', NULL, '2021-08-10', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL);

-- --------------------------------------------------------

--
-- Estructura de tabla para la tabla `reflugastro`
--

CREATE TABLE `reflugastro` (
  `id` int(55) NOT NULL,
  `date` varchar(555) DEFAULT NULL,
  `ver` varchar(22) NOT NULL DEFAULT 'si',
  `paciente` varchar(55) DEFAULT NULL,
  `pirosis` varchar(55) DEFAULT NULL,
  `pirosisDur` varchar(55) DEFAULT NULL,
  `pirosisFrec` varchar(55) DEFAULT NULL,
  `regur` varchar(55) DEFAULT NULL,
  `regurDur` varchar(55) DEFAULT NULL,
  `regurFrec` varchar(55) DEFAULT NULL,
  `dolPecho` varchar(55) DEFAULT NULL,
  `dolPechoDur` varchar(55) DEFAULT NULL,
  `dolPechoFrec` varchar(55) DEFAULT NULL,
  `disfagia` varchar(55) DEFAULT NULL,
  `disfagiaDur` varchar(55) DEFAULT NULL,
  `disfagiaFrec` varchar(55) DEFAULT NULL,
  `tos` varchar(55) DEFAULT NULL,
  `tosDur` varchar(55) DEFAULT NULL,
  `tosFrec` varchar(55) DEFAULT NULL,
  `disfonia` varchar(55) DEFAULT NULL,
  `disfoniaFrec` varchar(55) DEFAULT NULL,
  `disfoniaDur` varchar(55) DEFAULT NULL,
  `carras` varchar(55) DEFAULT NULL,
  `carrasFrec` varchar(55) DEFAULT NULL,
  `carrasDur` varchar(55) DEFAULT NULL,
  `broncoEs` varchar(55) DEFAULT NULL,
  `broncoEsFrec` varchar(55) DEFAULT NULL,
  `broncoEsDur` varchar(55) DEFAULT NULL,
  `refluDi` varchar(55) DEFAULT NULL,
  `refluDiFrec` varchar(55) DEFAULT NULL,
  `refluDiDur` varchar(55) DEFAULT NULL,
  `refluNoc` varchar(555) DEFAULT NULL,
  `refluNocDur` varchar(555) DEFAULT NULL,
  `refluNocFrec` varchar(555) DEFAULT NULL,
  `trastoSue` varchar(55) DEFAULT NULL,
  `trastoSueFrec` varchar(55) DEFAULT NULL,
  `trastoSueDur` varchar(55) DEFAULT NULL,
  `fracaBarr` varchar(55) DEFAULT NULL,
  `fracaBarrDur` varchar(55) DEFAULT NULL,
  `fracaBarrFrec` varchar(55) DEFAULT NULL,
  `sintoPerK` varchar(22) DEFAULT NULL,
  `sintoPerM` varchar(22) DEFAULT NULL,
  `sintoRumi` varchar(22) DEFAULT NULL,
  `escaGerdNum` varchar(22) DEFAULT NULL,
  `escaGerd8` varchar(22) DEFAULT NULL,
  `escaEckNum` varchar(22) DEFAULT NULL,
  `escaEck3` varchar(22) DEFAULT NULL,
  `escaCalVidNum` varchar(22) DEFAULT NULL,
  `escaCalVid3` varchar(22) DEFAULT NULL,
  `escaScoreNum` varchar(22) DEFAULT NULL,
  `escaScore45` varchar(22) DEFAULT NULL,
  `escaDepre` varchar(22) DEFAULT NULL,
  `escaAnsie` varchar(22) DEFAULT NULL,
  `escaSeve` varchar(22) DEFAULT NULL,
  `escaSeveNum` varchar(22) DEFAULT NULL,
  `escaAnsieNum` varchar(22) DEFAULT NULL,
  `escaDepreNum` varchar(22) DEFAULT NULL,
  `escaPeso` varchar(22) DEFAULT NULL,
  `escaTalla` varchar(22) DEFAULT NULL,
  `escaIMC` varchar(22) DEFAULT NULL,
  `somPHQ15` varchar(22) DEFAULT NULL,
  `somPHQ15Num` varchar(22) DEFAULT NULL,
  `fechaEndo` varchar(22) DEFAULT NULL,
  `endoErge` varchar(22) DEFAULT NULL,
  `endoDispe` varchar(22) DEFAULT NULL,
  `endoAbdo` varchar(22) DEFAULT NULL,
  `endoDiarrea` varchar(22) DEFAULT NULL,
  `endoAnemia` varchar(22) DEFAULT NULL,
  `endoMotOtros` text DEFAULT NULL,
  `endoMed` varchar(22) DEFAULT NULL,
  `endoMuco` varchar(22) DEFAULT NULL,
  `endoCambio` varchar(22) DEFAULT NULL,
  `endoPlie` varchar(22) DEFAULT NULL,
  `endoHiato` varchar(22) DEFAULT NULL,
  `endoEsoAnge` varchar(22) DEFAULT NULL,
  `endoLeng` varchar(22) DEFAULT NULL,
  `endomucoAsal` varchar(22) DEFAULT NULL,
  `endoPragaC` varchar(22) DEFAULT NULL,
  `endoPragaM` varchar(22) DEFAULT NULL,
  `endoBarret` varchar(22) DEFAULT NULL,
  `endoEsoEos` varchar(22) DEFAULT NULL,
  `endoOtroEso` text DEFAULT NULL,
  `endoConte` varchar(22) DEFAULT NULL,
  `endoCuerpo` varchar(22) DEFAULT NULL,
  `endoCuerpoOtros` varchar(22) DEFAULT NULL,
  `endoTecho` varchar(22) DEFAULT NULL,
  `endoTechoOtros` text DEFAULT NULL,
  `endoAngulo` varchar(22) DEFAULT NULL,
  `endoAnguloOtros` text DEFAULT NULL,
  `endoAntro` varchar(22) DEFAULT NULL,
  `endoAntroOtros` text DEFAULT NULL,
  `endoRetro` varchar(22) DEFAULT NULL,
  `endoBipHpylo` varchar(22) DEFAULT NULL,
  `endoPoliCuerpo` varchar(22) DEFAULT NULL,
  `endoEstoOtros` text DEFAULT NULL,
  `endoConteOtros` text DEFAULT NULL,
  `endoPoliTecho` varchar(22) DEFAULT NULL,
  `endoPoliAngulo` varchar(22) DEFAULT NULL,
  `endoPoliAntro` varchar(22) DEFAULT NULL,
  `endoPoliPolipec` varchar(22) DEFAULT NULL,
  `endoPoliFor` varchar(22) DEFAULT NULL,
  `endoPoliAnsa` varchar(22) DEFAULT NULL,
  `endoPoliMuco` varchar(22) DEFAULT NULL,
  `endoBulbo` varchar(22) DEFAULT NULL,
  `endoBulboOtros` text DEFAULT NULL,
  `endo2Duo` varchar(22) DEFAULT NULL,
  `endo2DuoOtros` text DEFAULT NULL,
  `endo2Bulbo` varchar(22) DEFAULT NULL,
  `endoCulti` varchar(22) DEFAULT NULL,
  `endoConclu2Duo` varchar(220) DEFAULT NULL,
  `endoConcluHernia` varchar(220) DEFAULT NULL,
  `endoConcluGastro` varchar(220) DEFAULT NULL,
  `endoConcluDismi` varchar(220) DEFAULT NULL,
  `endoConcluSospe` varchar(220) DEFAULT NULL,
  `endoConcluOtros` text DEFAULT NULL,
  `biopFecha` varchar(22) DEFAULT NULL,
  `biopEOE` varchar(22) DEFAULT NULL,
  `biopEOEnum` varchar(22) DEFAULT NULL,
  `biopEOEnegaPosi` varchar(22) DEFAULT NULL,
  `biopBarret` varchar(22) DEFAULT NULL,
  `biopBarretNum` varchar(22) DEFAULT NULL,
  `biopBarretNegaPosi` varchar(22) DEFAULT NULL,
  `biopDisplaGrado` varchar(22) DEFAULT NULL,
  `biopAdeno` varchar(22) DEFAULT NULL,
  `biopPylori` varchar(22) DEFAULT NULL,
  `biopPyloNum` varchar(22) DEFAULT NULL,
  `biopPyloNegaPosi` varchar(22) DEFAULT NULL,
  `biopObs` text DEFAULT NULL,
  `rxCierreLab` varchar(22) DEFAULT NULL,
  `rxElePala` varchar(22) DEFAULT NULL,
  `rxTranBolo` varchar(22) DEFAULT NULL,
  `rxIniRetar` varchar(22) DEFAULT NULL,
  `rxElePalaBlan` varchar(22) DEFAULT NULL,
  `rxEleLar` varchar(22) DEFAULT NULL,
  `rxContraFa` varchar(22) DEFAULT NULL,
  `rxAperEES` varchar(22) DEFAULT NULL,
  `rxCierreEES` varchar(22) DEFAULT NULL,
  `rxBarraCrico` varchar(22) DEFAULT NULL,
  `rxPene` varchar(22) DEFAULT NULL,
  `rxAspi` varchar(22) DEFAULT NULL,
  `rxRes` varchar(22) DEFAULT NULL,
  `rxDila` varchar(22) DEFAULT NULL,
  `rxDia` varchar(22) DEFAULT NULL,
  `rxDiver` varchar(22) DEFAULT NULL,
  `rxEste` varchar(22) DEFAULT NULL,
  `rxCana` varchar(22) DEFAULT NULL,
  `rxMin1` varchar(22) DEFAULT NULL,
  `rxMin1cm` varchar(22) DEFAULT NULL,
  `rxMin2` varchar(22) DEFAULT NULL,
  `rxMin2cm` varchar(22) DEFAULT NULL,
  `rxMin5` varchar(22) DEFAULT NULL,
  `rxMin5cm` varchar(22) DEFAULT NULL,
  `rxConclu` text DEFAULT NULL,
  `rxObs` text DEFAULT NULL,
  `rxEsteLon` varchar(222) DEFAULT NULL,
  `rxDiverLoca` varchar(222) DEFAULT NULL,
  `manoFecha` varchar(22) DEFAULT NULL,
  `manoErge` varchar(22) DEFAULT NULL,
  `manoDisfa` varchar(22) DEFAULT NULL,
  `manoDolPe` varchar(22) DEFAULT NULL,
  `manoIndi` text DEFAULT NULL,
  `manoCiru` varchar(22) DEFAULT NULL,
  `manoEndo` varchar(22) DEFAULT NULL,
  `manoProce` varchar(22) DEFAULT NULL,
  `manoMulti` text DEFAULT NULL,
  `manoVis` varchar(22) DEFAULT NULL,
  `manoSoli` varchar(22) DEFAULT NULL,
  `manoInspi` varchar(22) DEFAULT NULL,
  `mano200` varchar(22) DEFAULT NULL,
  `manoTras` varchar(22) DEFAULT NULL,
  `manoProx` varchar(22) DEFAULT NULL,
  `manoPip` varchar(22) DEFAULT NULL,
  `manoDis` varchar(22) DEFAULT NULL,
  `manoMorfo` varchar(22) DEFAULT NULL,
  `manoPreEEI` varchar(22) DEFAULT NULL,
  `manoPreRespiEEI` varchar(22) DEFAULT NULL,
  `manoPreInspiEEI` varchar(22) DEFAULT NULL,
  `manoIrp` varchar(22) DEFAULT NULL,
  `manoTran` varchar(22) DEFAULT NULL,
  `manoTranCom` varchar(22) DEFAULT NULL,
  `manoIrp1` varchar(22) DEFAULT NULL,
  `manoIrp2` varchar(22) DEFAULT NULL,
  `manoIrp3` varchar(22) DEFAULT NULL,
  `manoIrp4` varchar(22) DEFAULT NULL,
  `manoIrp5` varchar(22) DEFAULT NULL,
  `manoIrp6` varchar(22) DEFAULT NULL,
  `manoIrp7` varchar(22) DEFAULT NULL,
  `manoIrp8` varchar(22) DEFAULT NULL,
  `manoIrp9` varchar(22) DEFAULT NULL,
  `manoIrp10` varchar(22) DEFAULT NULL,
  `manoIrp11` varchar(22) DEFAULT NULL,
  `manoIrp12` varchar(22) DEFAULT NULL,
  `manoIrp13` varchar(22) DEFAULT NULL,
  `manoIrp14` varchar(22) DEFAULT NULL,
  `manoIrp15` varchar(22) DEFAULT NULL,
  `manoDci1` varchar(22) DEFAULT NULL,
  `manoDci2` varchar(22) DEFAULT NULL,
  `manoDci3` varchar(22) DEFAULT NULL,
  `manoDci4` varchar(22) DEFAULT NULL,
  `manoDci5` varchar(22) DEFAULT NULL,
  `manoDci6` varchar(22) DEFAULT NULL,
  `manoDci7` varchar(22) DEFAULT NULL,
  `manoDci8` varchar(22) DEFAULT NULL,
  `manoDci9` varchar(22) DEFAULT NULL,
  `manoDci10` varchar(22) DEFAULT NULL,
  `manoDci11` varchar(22) DEFAULT NULL,
  `manoDci12` varchar(22) DEFAULT NULL,
  `manoDci13` varchar(22) DEFAULT NULL,
  `manoDci14` varchar(22) DEFAULT NULL,
  `manoDci15` varchar(22) DEFAULT NULL,
  `manoLd1` varchar(22) DEFAULT NULL,
  `manoLd2` varchar(22) DEFAULT NULL,
  `manoLd3` varchar(22) DEFAULT NULL,
  `manoLd4` varchar(22) DEFAULT NULL,
  `manoLd5` varchar(22) DEFAULT NULL,
  `manoLd6` varchar(22) DEFAULT NULL,
  `manoLd7` varchar(22) DEFAULT NULL,
  `manoLd8` varchar(22) DEFAULT NULL,
  `manoLd9` varchar(22) DEFAULT NULL,
  `manoLd10` varchar(22) DEFAULT NULL,
  `manoLd11` varchar(22) DEFAULT NULL,
  `manoLd12` varchar(22) DEFAULT NULL,
  `manoLd13` varchar(22) DEFAULT NULL,
  `manoLd14` varchar(22) DEFAULT NULL,
  `manoLd15` varchar(22) DEFAULT NULL,
  `manoPresu1` varchar(22) DEFAULT NULL,
  `manoPresu2` varchar(22) DEFAULT NULL,
  `manoPresu3` varchar(22) DEFAULT NULL,
  `manoPresu4` varchar(22) DEFAULT NULL,
  `manoPresu5` varchar(22) DEFAULT NULL,
  `manoPresu6` varchar(22) DEFAULT NULL,
  `manoPresu7` varchar(22) DEFAULT NULL,
  `manoPresu8` varchar(22) DEFAULT NULL,
  `manoPresu9` varchar(22) DEFAULT NULL,
  `manoPresu10` varchar(22) DEFAULT NULL,
  `manoPresu11` varchar(22) DEFAULT NULL,
  `manoPresu12` varchar(22) DEFAULT NULL,
  `manoPresu13` varchar(22) DEFAULT NULL,
  `manoPresu14` varchar(22) DEFAULT NULL,
  `manoPresu15` varchar(22) DEFAULT NULL,
  `manoDiag1` varchar(11) DEFAULT NULL,
  `manoDiag2` varchar(11) DEFAULT NULL,
  `manoDiag3` varchar(11) DEFAULT NULL,
  `manoDiag4` varchar(11) DEFAULT NULL,
  `manoDiag5` varchar(22) DEFAULT NULL,
  `manoDiag6` varchar(22) DEFAULT NULL,
  `manoDiag7` varchar(22) DEFAULT NULL,
  `manoDiag8` varchar(22) DEFAULT NULL,
  `manoDiag9` varchar(22) DEFAULT NULL,
  `manoDiag10` varchar(22) DEFAULT NULL,
  `manoDiag11` varchar(22) DEFAULT NULL,
  `manoDiag12` varchar(22) DEFAULT NULL,
  `manoDiag13` varchar(22) DEFAULT NULL,
  `manoDiag14` varchar(22) DEFAULT NULL,
  `manoDiag15` varchar(22) DEFAULT NULL,
  `manoInhi` varchar(22) DEFAULT NULL,
  `manoReser` varchar(22) DEFAULT NULL,
  `manoAumen` varchar(22) DEFAULT NULL,
  `mano200cc` varchar(22) DEFAULT NULL,
  `manoVol` varchar(22) DEFAULT NULL,
  `mnanoVac1` varchar(22) DEFAULT NULL,
  `manoVac5` varchar(22) DEFAULT NULL,
  `manoPres` varchar(22) DEFAULT NULL,
  `manoRel` varchar(22) DEFAULT NULL,
  `manoAcos` varchar(22) DEFAULT NULL,
  `manoPie` varchar(22) DEFAULT NULL,
  `manoRumi` varchar(22) DEFAULT NULL,
  `manoEruc` varchar(22) DEFAULT NULL,
  `manoObs` text DEFAULT NULL,
  `manoEsfi` varchar(22) DEFAULT NULL,
  `manoRel2` varchar(22) DEFAULT NULL,
  `manoUG` varchar(22) DEFAULT NULL,
  `manoPeris` varchar(22) DEFAULT NULL,
  `manoAper` varchar(22) DEFAULT NULL,
  `manoDci450` varchar(22) DEFAULT NULL,
  `manoDci8000` varchar(22) DEFAULT NULL,
  `manoDci100` varchar(22) DEFAULT NULL,
  `mano450` varchar(22) DEFAULT NULL,
  `manoBre` varchar(22) DEFAULT NULL,
  `manoLat45` varchar(22) DEFAULT NULL,
  `manoLat45s` varchar(22) DEFAULT NULL,
  `manoPresu` varchar(22) DEFAULT NULL,
  `manoMulti2` varchar(22) DEFAULT NULL,
  `manoVacEso` varchar(22) DEFAULT NULL,
  `manoAumenPre` varchar(22) DEFAULT NULL,
  `manoCNor` varchar(22) DEFAULT NULL,
  `manoCAca` varchar(22) DEFAULT NULL,
  `manoCPeris` varchar(22) DEFAULT NULL,
  `manoCAus` varchar(22) DEFAULT NULL,
  `manoCJack` varchar(22) DEFAULT NULL,
  `manoCEspa` varchar(22) DEFAULT NULL,
  `manoNotas` text DEFAULT NULL,
  `IMPEfecha` varchar(22) DEFAULT NULL,
  `IMPEmed` varchar(22) DEFAULT NULL,
  `IMPEtipo` varchar(22) DEFAULT NULL,
  `IMPEtec` text DEFAULT NULL,
  `IMPEexa` text DEFAULT NULL,
  `IMPEcomen` text DEFAULT NULL,
  `IMPEdurEst` varchar(22) DEFAULT NULL,
  `IMPEtotaPh` varchar(22) DEFAULT NULL,
  `IMPEphPie` varchar(22) DEFAULT NULL,
  `IMPEphCubito` varchar(22) DEFAULT NULL,
  `IMPErefluTotal` varchar(22) DEFAULT NULL,
  `IMPErefluAcid` varchar(22) DEFAULT NULL,
  `IMPErefluNoAcid` varchar(22) DEFAULT NULL,
  `IMPErefluExten` varchar(22) DEFAULT NULL,
  `IMPEasoSinto` varchar(22) DEFAULT NULL,
  `IMPEhcDisfo` varchar(22) DEFAULT NULL,
  `IMPEindiSinto` varchar(22) DEFAULT NULL,
  `IMPEasoProba` varchar(22) DEFAULT NULL,
  `IMPEohmsC5` varchar(22) DEFAULT NULL,
  `IMPEohmsC6` text DEFAULT NULL,
  `IMPEohmsPro` varchar(22) DEFAULT NULL,
  `IMPEerucSupra` text DEFAULT NULL,
  `IMPEerucGas` varchar(22) DEFAULT NULL,
  `IMPEcomen2` text DEFAULT NULL,
  `IMPErefluAcid2` varchar(22) DEFAULT NULL,
  `IMPEfracaBarre` varchar(22) DEFAULT NULL,
  `IMPEesoHiper` varchar(22) DEFAULT NULL,
  `IMPEeruGastroFrecu` varchar(22) DEFAULT NULL,
  `IMPEparaFisio` varchar(22) DEFAULT NULL,
  `acidFol` varchar(22) DEFAULT NULL,
  `AlbuminaNum` varchar(22) DEFAULT NULL,
  `AntiRNPNum` varchar(22) DEFAULT NULL,
  `AntiSCL70Num` varchar(22) DEFAULT NULL,
  `CalcioNum` varchar(22) DEFAULT NULL,
  `CalprotectinaNum` varchar(22) DEFAULT NULL,
  `clx1atp` varchar(22) DEFAULT NULL,
  `ColesteroltotalNum` varchar(22) DEFAULT NULL,
  `CreatininaNum` varchar(22) DEFAULT NULL,
  `dgp` varchar(22) DEFAULT NULL,
  `dgpScreen` varchar(22) DEFAULT NULL,
  `dq2` varchar(22) DEFAULT NULL,
  `dq8` varchar(22) DEFAULT NULL,
  `ElastasafecalNum` varchar(22) DEFAULT NULL,
  `ERSNum` varchar(22) DEFAULT NULL,
  `estea` varchar(22) DEFAULT NULL,
  `FANNum` varchar(22) DEFAULT NULL,
  `FosforoNum` varchar(22) DEFAULT NULL,
  `GlBlNum` varchar(22) DEFAULT NULL,
  `GlucemiaNum` varchar(22) DEFAULT NULL,
  `HDLNum` varchar(22) DEFAULT NULL,
  `HtoNum` varchar(22) DEFAULT NULL,
  `HbA1Num` varchar(22) DEFAULT NULL,
  `Hb` varchar(22) DEFAULT NULL,
  `hepatoBT` varchar(22) DEFAULT NULL,
  `hepatoBD` varchar(22) DEFAULT NULL,
  `hepatoTGO` varchar(22) DEFAULT NULL,
  `hepatoTGP` varchar(22) DEFAULT NULL,
  `hepatoFAL` varchar(22) DEFAULT NULL,
  `hiv` varchar(22) DEFAULT NULL,
  `IgATotalNum` varchar(22) DEFAULT NULL,
  `IgAattgNum` varchar(22) DEFAULT NULL,
  `IgAdgpNum` varchar(22) DEFAULT NULL,
  `IgGdgpNum` varchar(22) DEFAULT NULL,
  `igaEma` varchar(22) DEFAULT NULL,
  `iggEma` varchar(22) DEFAULT NULL,
  `IonogramaNum` varchar(22) DEFAULT NULL,
  `KPTTNum` varchar(22) DEFAULT NULL,
  `LDLNum` varchar(22) DEFAULT NULL,
  `MagnesioNum` varchar(22) DEFAULT NULL,
  `ParasitologicoNum` varchar(22) DEFAULT NULL,
  `parasito` varchar(22) DEFAULT NULL,
  `PCRNum` varchar(22) DEFAULT NULL,
  `PlaqNum` varchar(22) DEFAULT NULL,
  `PotasioNum` varchar(22) DEFAULT NULL,
  `PrealbuminaNum` varchar(22) DEFAULT NULL,
  `ProteinasNum` varchar(22) DEFAULT NULL,
  `SodioNum` varchar(22) DEFAULT NULL,
  `t3` varchar(22) DEFAULT NULL,
  `t4` varchar(22) DEFAULT NULL,
  `t4l` varchar(22) DEFAULT NULL,
  `TPNum` varchar(22) DEFAULT NULL,
  `TrigliceridosNum` varchar(22) DEFAULT NULL,
  `TSHNum` varchar(22) DEFAULT NULL,
  `ureaNum` varchar(22) DEFAULT NULL,
  `vitB12` varchar(22) DEFAULT NULL,
  `VitdNum` varchar(22) DEFAULT NULL,
  `DdisfaOro` varchar(22) DEFAULT NULL,
  `Dparkin` varchar(222) DEFAULT NULL,
  `DdisfuNeurox` varchar(222) DEFAULT NULL,
  `DbarraCricox` varchar(222) DEFAULT NULL,
  `DesteOrga` varchar(222) DEFAULT NULL,
  `DdisfaEso` varchar(222) DEFAULT NULL,
  `DesteOrga1` varchar(222) DEFAULT NULL,
  `DbeniMali` varchar(222) DEFAULT NULL,
  `DcarciAdeno` varchar(222) DEFAULT NULL,
  `DtrastoEso` varchar(222) DEFAULT NULL,
  `Dacalasia` varchar(222) DEFAULT NULL,
  `DostruUGE` varchar(222) DEFAULT NULL,
  `DespaEso` varchar(222) DEFAULT NULL,
  `DauseContra` varchar(222) DEFAULT NULL,
  `Djackh` varchar(222) DEFAULT NULL,
  `DmotiIne` varchar(222) DEFAULT NULL,
  `DEEI` varchar(222) DEFAULT NULL,
  `DesoEos` varchar(222) DEFAULT NULL,
  `DeroNoero` varchar(222) DEFAULT NULL,
  `DesoHiper` varchar(222) DEFAULT NULL,
  `DpiroFun` varchar(222) DEFAULT NULL,
  `Dbarret` varchar(222) DEFAULT NULL,
  `DbarretDiag` varchar(222) DEFAULT NULL,
  `DergeSupra` varchar(222) DEFAULT NULL,
  `Dtos` varchar(22) DEFAULT NULL,
  `Dasma` varchar(222) DEFAULT NULL,
  `Dlarin` varchar(222) DEFAULT NULL,
  `Dglo` varchar(222) DEFAULT NULL,
  `Deructos` varchar(222) DEFAULT NULL,
  `DerucDiag` varchar(222) DEFAULT NULL,
  `DpostOpe` varchar(222) DEFAULT NULL,
  `Dfecha` varchar(222) DEFAULT NULL
) ENGINE=MyISAM DEFAULT CHARSET=latin1;

--
-- Volcado de datos para la tabla `reflugastro`
--

INSERT INTO `reflugastro` (`id`, `date`, `ver`, `paciente`, `pirosis`, `pirosisDur`, `pirosisFrec`, `regur`, `regurDur`, `regurFrec`, `dolPecho`, `dolPechoDur`, `dolPechoFrec`, `disfagia`, `disfagiaDur`, `disfagiaFrec`, `tos`, `tosDur`, `tosFrec`, `disfonia`, `disfoniaFrec`, `disfoniaDur`, `carras`, `carrasFrec`, `carrasDur`, `broncoEs`, `broncoEsFrec`, `broncoEsDur`, `refluDi`, `refluDiFrec`, `refluDiDur`, `refluNoc`, `refluNocDur`, `refluNocFrec`, `trastoSue`, `trastoSueFrec`, `trastoSueDur`, `fracaBarr`, `fracaBarrDur`, `fracaBarrFrec`, `sintoPerK`, `sintoPerM`, `sintoRumi`, `escaGerdNum`, `escaGerd8`, `escaEckNum`, `escaEck3`, `escaCalVidNum`, `escaCalVid3`, `escaScoreNum`, `escaScore45`, `escaDepre`, `escaAnsie`, `escaSeve`, `escaSeveNum`, `escaAnsieNum`, `escaDepreNum`, `escaPeso`, `escaTalla`, `escaIMC`, `somPHQ15`, `somPHQ15Num`, `fechaEndo`, `endoErge`, `endoDispe`, `endoAbdo`, `endoDiarrea`, `endoAnemia`, `endoMotOtros`, `endoMed`, `endoMuco`, `endoCambio`, `endoPlie`, `endoHiato`, `endoEsoAnge`, `endoLeng`, `endomucoAsal`, `endoPragaC`, `endoPragaM`, `endoBarret`, `endoEsoEos`, `endoOtroEso`, `endoConte`, `endoCuerpo`, `endoCuerpoOtros`, `endoTecho`, `endoTechoOtros`, `endoAngulo`, `endoAnguloOtros`, `endoAntro`, `endoAntroOtros`, `endoRetro`, `endoBipHpylo`, `endoPoliCuerpo`, `endoEstoOtros`, `endoConteOtros`, `endoPoliTecho`, `endoPoliAngulo`, `endoPoliAntro`, `endoPoliPolipec`, `endoPoliFor`, `endoPoliAnsa`, `endoPoliMuco`, `endoBulbo`, `endoBulboOtros`, `endo2Duo`, `endo2DuoOtros`, `endo2Bulbo`, `endoCulti`, `endoConclu2Duo`, `endoConcluHernia`, `endoConcluGastro`, `endoConcluDismi`, `endoConcluSospe`, `endoConcluOtros`, `biopFecha`, `biopEOE`, `biopEOEnum`, `biopEOEnegaPosi`, `biopBarret`, `biopBarretNum`, `biopBarretNegaPosi`, `biopDisplaGrado`, `biopAdeno`, `biopPylori`, `biopPyloNum`, `biopPyloNegaPosi`, `biopObs`, `rxCierreLab`, `rxElePala`, `rxTranBolo`, `rxIniRetar`, `rxElePalaBlan`, `rxEleLar`, `rxContraFa`, `rxAperEES`, `rxCierreEES`, `rxBarraCrico`, `rxPene`, `rxAspi`, `rxRes`, `rxDila`, `rxDia`, `rxDiver`, `rxEste`, `rxCana`, `rxMin1`, `rxMin1cm`, `rxMin2`, `rxMin2cm`, `rxMin5`, `rxMin5cm`, `rxConclu`, `rxObs`, `rxEsteLon`, `rxDiverLoca`, `manoFecha`, `manoErge`, `manoDisfa`, `manoDolPe`, `manoIndi`, `manoCiru`, `manoEndo`, `manoProce`, `manoMulti`, `manoVis`, `manoSoli`, `manoInspi`, `mano200`, `manoTras`, `manoProx`, `manoPip`, `manoDis`, `manoMorfo`, `manoPreEEI`, `manoPreRespiEEI`, `manoPreInspiEEI`, `manoIrp`, `manoTran`, `manoTranCom`, `manoIrp1`, `manoIrp2`, `manoIrp3`, `manoIrp4`, `manoIrp5`, `manoIrp6`, `manoIrp7`, `manoIrp8`, `manoIrp9`, `manoIrp10`, `manoIrp11`, `manoIrp12`, `manoIrp13`, `manoIrp14`, `manoIrp15`, `manoDci1`, `manoDci2`, `manoDci3`, `manoDci4`, `manoDci5`, `manoDci6`, `manoDci7`, `manoDci8`, `manoDci9`, `manoDci10`, `manoDci11`, `manoDci12`, `manoDci13`, `manoDci14`, `manoDci15`, `manoLd1`, `manoLd2`, `manoLd3`, `manoLd4`, `manoLd5`, `manoLd6`, `manoLd7`, `manoLd8`, `manoLd9`, `manoLd10`, `manoLd11`, `manoLd12`, `manoLd13`, `manoLd14`, `manoLd15`, `manoPresu1`, `manoPresu2`, `manoPresu3`, `manoPresu4`, `manoPresu5`, `manoPresu6`, `manoPresu7`, `manoPresu8`, `manoPresu9`, `manoPresu10`, `manoPresu11`, `manoPresu12`, `manoPresu13`, `manoPresu14`, `manoPresu15`, `manoDiag1`, `manoDiag2`, `manoDiag3`, `manoDiag4`, `manoDiag5`, `manoDiag6`, `manoDiag7`, `manoDiag8`, `manoDiag9`, `manoDiag10`, `manoDiag11`, `manoDiag12`, `manoDiag13`, `manoDiag14`, `manoDiag15`, `manoInhi`, `manoReser`, `manoAumen`, `mano200cc`, `manoVol`, `mnanoVac1`, `manoVac5`, `manoPres`, `manoRel`, `manoAcos`, `manoPie`, `manoRumi`, `manoEruc`, `manoObs`, `manoEsfi`, `manoRel2`, `manoUG`, `manoPeris`, `manoAper`, `manoDci450`, `manoDci8000`, `manoDci100`, `mano450`, `manoBre`, `manoLat45`, `manoLat45s`, `manoPresu`, `manoMulti2`, `manoVacEso`, `manoAumenPre`, `manoCNor`, `manoCAca`, `manoCPeris`, `manoCAus`, `manoCJack`, `manoCEspa`, `manoNotas`, `IMPEfecha`, `IMPEmed`, `IMPEtipo`, `IMPEtec`, `IMPEexa`, `IMPEcomen`, `IMPEdurEst`, `IMPEtotaPh`, `IMPEphPie`, `IMPEphCubito`, `IMPErefluTotal`, `IMPErefluAcid`, `IMPErefluNoAcid`, `IMPErefluExten`, `IMPEasoSinto`, `IMPEhcDisfo`, `IMPEindiSinto`, `IMPEasoProba`, `IMPEohmsC5`, `IMPEohmsC6`, `IMPEohmsPro`, `IMPEerucSupra`, `IMPEerucGas`, `IMPEcomen2`, `IMPErefluAcid2`, `IMPEfracaBarre`, `IMPEesoHiper`, `IMPEeruGastroFrecu`, `IMPEparaFisio`, `acidFol`, `AlbuminaNum`, `AntiRNPNum`, `AntiSCL70Num`, `CalcioNum`, `CalprotectinaNum`, `clx1atp`, `ColesteroltotalNum`, `CreatininaNum`, `dgp`, `dgpScreen`, `dq2`, `dq8`, `ElastasafecalNum`, `ERSNum`, `estea`, `FANNum`, `FosforoNum`, `GlBlNum`, `GlucemiaNum`, `HDLNum`, `HtoNum`, `HbA1Num`, `Hb`, `hepatoBT`, `hepatoBD`, `hepatoTGO`, `hepatoTGP`, `hepatoFAL`, `hiv`, `IgATotalNum`, `IgAattgNum`, `IgAdgpNum`, `IgGdgpNum`, `igaEma`, `iggEma`, `IonogramaNum`, `KPTTNum`, `LDLNum`, `MagnesioNum`, `ParasitologicoNum`, `parasito`, `PCRNum`, `PlaqNum`, `PotasioNum`, `PrealbuminaNum`, `ProteinasNum`, `SodioNum`, `t3`, `t4`, `t4l`, `TPNum`, `TrigliceridosNum`, `TSHNum`, `ureaNum`, `vitB12`, `VitdNum`, `DdisfaOro`, `Dparkin`, `DdisfuNeurox`, `DbarraCricox`, `DesteOrga`, `DdisfaEso`, `DesteOrga1`, `DbeniMali`, `DcarciAdeno`, `DtrastoEso`, `Dacalasia`, `DostruUGE`, `DespaEso`, `DauseContra`, `Djackh`, `DmotiIne`, `DEEI`, `DesoEos`, `DeroNoero`, `DesoHiper`, `DpiroFun`, `Dbarret`, `DbarretDiag`, `DergeSupra`, `Dtos`, `Dasma`, `Dlarin`, `Dglo`, `Deructos`, `DerucDiag`, `DpostOpe`, `Dfecha`) VALUES
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`SodioNum`, `t3`, `t4`, `t4l`, `TPNum`, `TrigliceridosNum`, `TSHNum`, `ureaNum`, `vitB12`, `VitdNum`, `DdisfaOro`, `Dparkin`, `DdisfuNeurox`, `DbarraCricox`, `DesteOrga`, `DdisfaEso`, `DesteOrga1`, `DbeniMali`, `DcarciAdeno`, `DtrastoEso`, `Dacalasia`, `DostruUGE`, `DespaEso`, `DauseContra`, `Djackh`, `DmotiIne`, `DEEI`, `DesoEos`, `DeroNoero`, `DesoHiper`, `DpiroFun`, `Dbarret`, `DbarretDiag`, `DergeSupra`, `Dtos`, `Dasma`, `Dlarin`, `Dglo`, `Deructos`, `DerucDiag`, `DpostOpe`, `Dfecha`) VALUES
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-- --------------------------------------------------------

--
-- Estructura de tabla para la tabla `rp`
--

CREATE TABLE `rp` (
  `id` int(22) NOT NULL,
  `osNum` varchar(52) DEFAULT NULL,
  `pac` varchar(22) DEFAULT NULL,
  `usr` varchar(99) DEFAULT NULL,
  `date` timestamp NOT NULL DEFAULT current_timestamp(),
  `fechaOrden` varchar(222) DEFAULT NULL,
  `logo` varchar(22) DEFAULT NULL,
  `descrip1` text DEFAULT NULL,
  `descrip2` varchar(222) DEFAULT NULL,
  `descrip3` varchar(222) DEFAULT NULL,
  `descrip4` varchar(222) DEFAULT NULL,
  `descrip5` varchar(222) DEFAULT NULL,
  `indi1` varbinary(222) DEFAULT NULL,
  `indi2` varchar(222) DEFAULT NULL,
  `indi3` varchar(222) DEFAULT NULL,
  `indi4` varchar(222) DEFAULT NULL,
  `indi5` varchar(222) DEFAULT NULL,
  `numC1` varchar(22) DEFAULT NULL,
  `numC2` varchar(22) DEFAULT NULL,
  `numC3` varchar(22) DEFAULT NULL,
  `numC4` varchar(22) DEFAULT NULL,
  `numC5` varchar(22) DEFAULT NULL,
  `numT1` varchar(11) DEFAULT NULL,
  `numT2` varchar(11) DEFAULT NULL,
  `numT3` varchar(11) DEFAULT NULL,
  `numT4` varchar(11) DEFAULT NULL,
  `numT5` varchar(11) DEFAULT NULL,
  `os` varchar(22) DEFAULT NULL,
  `obsRP` text DEFAULT NULL,
  `obsIndi` text DEFAULT NULL,
  `dupli` varchar(2) DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8;

--
-- Volcado de datos para la tabla `rp`
--

INSERT INTO `rp` (`id`, `osNum`, `pac`, `usr`, `date`, `fechaOrden`, `logo`, `descrip1`, `descrip2`, `descrip3`, `descrip4`, `descrip5`, `indi1`, `indi2`, `indi3`, `indi4`, `indi5`, `numC1`, `numC2`, `numC3`, `numC4`, `numC5`, `numT1`, `numT2`, `numT3`, `numT4`, `numT5`, `os`, `obsRP`, `obsIndi`, `dupli`) VALUES
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(15, NULL, '328', 'Piskorz', '2016-06-29 11:55:53', NULL, NULL, 'ECOGRAFIA TRANSPERINEAL 3D', NULL, NULL, NULL, NULL, 0x434f4e535449504143494f4e205449504f204f54530a524543544f43454c4520414e544552494f52, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(19, NULL, '1167', 'Stefanolo', '2017-05-11 15:02:30', NULL, NULL, 'RIFADOM 550\r\nRIFAXIMINA 550 COMP X 60 \r\n1=UNO', NULL, NULL, NULL, NULL, 0x3120434f4d2043203820504f522031342044494153, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL),
(25, NULL, '2905', 'INSAURRALDE', '2019-03-21 11:16:23', NULL, NULL, 'PANTOPRAZOL 20 MG COMP X30 (PANTUS)\nBAREX UNIPEG SOBRES X 24', NULL, NULL, NULL, NULL, 0x50414e544f5052415a4f4c203120434f4d5020504f522044494120414e5445532044454c204445534159554e4f0a42415245582044494c55495220554e20534f42524520454e20554e205641534f20444520414755412c204841535441203220534f4252455320504f522044494120534547554e20434f4e53495354454e434941204445204d41544552494120464543414c2e20454e204341534f2044452044494152524541204449534d494e554952204c412043414e544944414420444520534f425245532e20, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'SIN OS', NULL, NULL, NULL),
(26, NULL, '2225', 'INSAURRALDE', '2019-04-09 13:27:25', NULL, NULL, 'neomicina 250 mg comp x 16 por 2 cajas \nrifaximina 550 mg comp x 60 ', NULL, NULL, NULL, NULL, 0x6e656f6d6963696e61203220636f6d7020632f2031322068730a7269666178696d696e61203120632f386873200a200a647572616e74652031342064696173, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DOSUBA', NULL, NULL, NULL),
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