Introduction: During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. Objective: The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. Materials and methods: We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. Results: With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer duringthe pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. Conclusion: The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.

A 15-year-old male patient presented with dysphagia, regurgitation, weight loss and retrosternal pain. The diagnosis of achalasia was made 4 years before. The esophagogram revealed severe esophagus dilatation and the classic “bird-beak” termination. A Heller myotomy plus fundoplication and endoscopic balloon dilatation were conducted four months previously. Nevertheless, the symptoms persisted and the last high-resolution manometry study still showed achalasia type II. The patient underwent a peroral endoscopic esophageal myotomy (POEM). POEM is a feasible and safe procedure for experienced and properly- equipped health care delivery centers and could be used as a rescue treatment in refr e present the youngest patient with achalasia in our region who had a successful response to rescue POEM.

artículos originalesEfecto terapéutico del extracto etanólico de Erythroxylum coca spp. en anemia ferropénica inducida en ratas Holtzman macho ResumenIntroducción: La hoja de coca ha sido usada tradicionalmente con fines medicinales y contiene altos niveles de hierro. Objetivos: Determinar el efecto del extracto etanólico de Erythroxylum coca spp. frente a anemia ferropénica inducida por dieta deficiente en hierro, en ratas Holtzman macho. Diseño: Experimental. Lugar: Laboratorio del Instituto de Patología, Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Material biológico: Dieciocho ratas Holtzman macho de 16 días de edad recién destetadas. Intervenciones: Se formó tres grupos de seis ratas cada uno: a) grupo hierro suficiente (HS), recibió 25 g/d de alimento balanceado durante 7 semanas; b) grupo hierro deficiente (HD), recibió 25 g/d de dieta ferropénica durante 7 semanas; y, c) el grupo hierro deficiente -extracto E. coca (HD-EC), recibió 25 g/d de dieta ferropénica durante 7 semanas y a partir de la semana 5 se agregó 18 g/d de extracto de E. coca. Principales medidas de resultados: Nivel sérico de hemoglobina, peso y talla. Resultados: Al finalizar el tratamiento, se observó aumento significativo de la hemoglobina en el grupo HD-EC (p=0,04). Se encontró diferencia significativa en los niveles séricos de hemoglobina entre los grupos HD-EC y HD (p=0,0062). No se encontró diferencia significativa en los valores de hemoglobina entre los grupos HD-EC y HS (p= 0,06). No se evidenció diferencia en el peso y la talla entre los grupos HD y HD-EC (p=0,20 y p=0,23, respectivamente). Conclusiones: E. coca presenta efecto antianémico experimental, sustentado en los resultados de los niveles de hemoglobina. Palabras clave: Coca, anemia ferropénica, hemoglobina, ratas Holtzman. Abstract Introduction: Coca leaf has been traditionally used for medical purposes and contains high iron levels. Objective: To determine the effect of Erythroxylum coca spp. ethanol extract in iron-deficiency anemia induced by iron-deficient diet in male Holtzman rats. Design: Experimental. Setting: Institute of Pathology Laboratory, Universidad Nacional Mayor de San Marcos. Biologic material: Eighteen weaned male Holtzman rats 16 days old. Interventions: Rats were allocated to three groups of six rats each: a) iron-sufficient group (IS) received 25 g/d of balanced diet for 7 weeks; b) iron-deficient group (ID) received 25 g/d of iron-deficient diet for 7 weeks; and, c) irondeficient/E. coca extract group (ID-CE) received 25 g/d of iron-deficient diet for 7 weeks, and in the fifth week 18 g/d of E. coca extract were added. Main outcome measures: Serum hemoglobin level, weight and height. Results: At the end of the treatment, there was significant difference of hemoglobin in the ID-CE group (p=0.04). There was significant difference in serum hemoglobin levels between ID-CE and ID groups (p=0.0062). No significant difference was found in serum hemoglobin levels between ID-CE and IS groups (p=0.06). No significant difference was foun...