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INTRODUCTION: Bariatric surgery is established as a possibility for the treatment of obesity, allowing weight reduction and remission of obesity comorbidities. Reported suboptimal clinical response rates are as high as 30-60% (insufficient weight loss or gain, defined as BMI greater than 35 kg/m2 or excess weight loss less than 50%). Proximal jejuno-ileal bypass (PJIBP) is a promising option when re-intervention is required. OBJECTIVES: To describe the standardization of a proprietary technique of modified PJIBP as a management procedure in patients with post-gastric bypass recurrent weight gain or insufficient post-intervention weight loss. METHODS: This study evaluated a case series of 10 Latin American patients requiring post-bariatric re-intervention, between February 2018 and 2023, in a single-metabolic surgery center in Cali-Colombia. RESULTS: Median age was 45 years (26-70 RIC), 60% female, and 40% male. Mean BMI at conversion was 36.7 kg/m2 (6.4 SD). Median follow-up was 22 months (RIC 16-30). Mean percentage of excess weight lost was 78% (22.4 SD). One hundred percent achieved glycemia control, only one patient persisted with dyslipidemia, and no patient presented hypoalbuminemia. At the end of follow-up, 100% received vitamin supplementation. CONCLUSION: PJIBP could be an effective procedure, associated with positive results in relation to weight loss and resolution of obesity comorbidities. Deficiencies of fat-soluble vitamins and protein malnutrition represent the main concern in the long term, so multidisciplinary management and continuous follow-up are required.

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We studied the chemical composition and the in vivo AMEn content and apparent (AID) and standardized (SID) ileal digestibility of CP and amino acids (AA) of 27 samples of soybean meals (SBM) from Argentina (ARG), Brazil (BRA), and USA, collected in Spain. On 88% DM basis, the BRA meals had more CP (46.9 vs. 46.0 and 45.9%; P < 0.05) and less sucrose (5.21 vs. 6.28 and 6.47%; P < 0.001) and stachyose (4.20 vs. 4.66 and 4.78%; P < 0.05) than the USA and ARG meals. Urease activity, protein dispersibility index, KOH protein solubility, and trypsin inhibitor activity values, were higher for the USA meals than for the South American meals (P < 0.05). In the in vivo trial, broilers received a common crumble diet from 0 to 16 d of age and then, their respective experimental diets (53% of a N-free diet and 47% of each of the 27 SBM tested) in mash form, for 5 d. The AMEn (2,334 vs. 2,282 and 2,277 kcal/kg; P = 0.062) and the AID (87.3 vs. 86.7 and 86.4%; P = 0.054) and SID (91.9 vs. 91.2 and 90.8%; P < 0.05) of the protein, were greater for the USA meals than for the ARG and BRA meals. In fact, the SID of Lys (93.5 vs. 93.0 and 92.1%; P < 0.001) and of the sum of Lys, Met, Thr, Trp, and Cys (91.4 vs. 91.0 and 90.2%; P < 0.05) were greater for the USA meals than for the ARG and BRA meals. In summary, the chemical composition, protein quality indicators, AMEn content, and ileal digestibility of the CP and the AA of the SBM, varied with the country of origin of the soybeans. In order to increase the accuracy of the feed formulation process, the composition and nutrient content of commercial batches of SBM, by country of origin should be controlled and periodically updated.

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Two trials were performed in order to evaluate the effects of dietary Kraft lignin inclusion on broiler performance, ileal nutrient digestibility, blood lipid profile, intestinal morphometry, and lipid oxidation of meat. Trial 1 was conducted in order to evaluate performance and ileal digestibility for the period of 1 to 21 d of age, randomly distributing 490 day-old broiler chicks across 5 dietary treatments with 14 replicates containing 7 birds each in metabolic cages, while trial 2 was executed in order to evaluate performance, blood parameters, intestinal morphometry, carcass yield and abdominal fat, and lipid oxidation for the period of 1 to 42 d of age, randomly distributing 900 day-old broiler chicks across 5 dietary treatments with 15 replicates of 12 birds each in floor pens, being each bird in trial 2 challenged with coccidiosis vaccine at 10 d of age. The treatments used in both trials were: positive control (PC): basal diet + antimicrobial; negative control (NC): Basal diet; NC1: NC + 1% lignin; NC2: NC + 2% lignin; NC3: NC + 3% lignin. For trial 1, it was observed that birds fed diets containing 1% lignin had a significant positive effect for BW, feed intake (FI), average daily weight gain (BWG) and feed conversion rate (FCR), similar to the PC, but also showing better EE, CP and AAs ileal digestibility percentages when compared to other treatments. For trial 2, it was observed that during the period of 21 to 35 d, the inclusion of lignin in the diet provided better results in animal performance, similar to the PC group, but at 42 d, animals fed with dietary lignin showed results lower than animals fed the PC diet (P < 0.05). Animals fed with increasing lignin concentrations showed decreasing levels of HDL (P < 0.05). As of intestinal morphometry, animals fed with 1% and 3% lignin showed longer intestinal length (P < 0.05). At 14 d of age, it was observed that animals fed with lignin showed oxidation levels similar to the control treatments. The inclusion of up to 1% lignin in the diet provides beneficial effects on productive performance and nutrient digestibility, while the inclusion of 2% lignin provided lower cholesterol levels, lower villus/crypt ratio, and better internal organ development, therefore, it can be considered an alternative to performance-enhancing antimicrobials in broiler chicken diets.

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This study investigated the effects of xylanase and stimbiotic (fiber fermentation enhancer) on the response of broiler chickens fed different corn varieties and determine correlations between variables of interest. Four corn genetic varieties were selected based on their range in nutrient composition. Diets containing 600 g/kg of each corn were supplemented with 0 or 100 g/ton of xylanase or stimbiotic. A total of 1,152 one-day-old male broiler chicks (Ross 308) were divided into 12 treatments, each with 8 pens and 12 birds per pen, for a 21-day study. On d 21, performance parameters were measured, and the ileal energy and organic matter (OM) digestibility and cecal xylanase activity determined. Stimbiotic supplementation improved mFCR compared with all other treatments. There was a treatment by corn variety interaction for body weight (BW), BW gain and coefficient of variation (CV) of BW (P ≤ 0.05). Birds fed corn Variety 1 (highest neutral dietary fiber, protein and soluble arabinoxylan content) supplemented with stimbiotic had the highest BW, while Variety 2 control diet had the lowest. The BW CV in corn Variety 2 was the highest, which improved with stimbiotic supplementation. The BW CV in corn Variety 1 responded better to stimbiotic than xylanase. There were no treatment differences on BW CV in corn Varieties 3 and 4. The lowest OM digestibility was observed in birds fed corn Variety 1 with xylanase, and the highest value was associated with corn Variety 3 with xylanase (highest total arabinoxylan). Xylanase and stimbiotic supplementation increased the endogenous xylanase activity regardless of the corn variety (P ≤ 0.05). Positive correlations between corn fiber contents and phytic acid and the arabinose:xylose ratio were seen, while nonstarch polysaccharide content was negatively correlated with apparent metabolizable energy. In conclusion, corn variety influenced nutrient digestibility and broiler chicken growth. The response to supplementation with xylanase or stimbiotic varied based on the nutritional profile of corn with regards to improvements in digestibility and performance in broiler chickens.

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RESUMEN La obstrucción intestinal inducida por íleo biliar es una condición rara pero significativa que se produce cuando una piedra en la vesícula se aloja en el tracto gastrointestinal. Entre los principales factores de riesgo para la obstrucción intestinal inducida por íleo biliar se encuentran la edad avanzada, el sexo femenino, la diabetes, los antecedentes de enfermedad biliar como cálculos biliares, así como procedimientos quirúrgicos previos relacionados con la vesícula biliar, como la colecistectomía. También el embarazo es un factor de riesgo conocido para la enfermedad de los cálculos biliares. En este artículo, se presenta el caso de una paciente de 38 años con antecedentes de tres cesáreas previas y sin comorbilidades aparentes. Antes de acudir al departamento de emergencias, la paciente experimentó dolor abdominal con cólico moderado en la parte inferior del abdomen durante dos días. El examen físico reveló sensibilidad abdominal difusa, predominantemente en la fosa ilíaca derecha, junto con signos de irritación peritoneal. Los análisis de laboratorio mostraron un recuento de leucocitos de 11 490 células/μl y una neutrofilia del 85,6 %. Después de una laparotomía exploratoria, se confirmó el diagnóstico sospechado de íleo biliar por cálculo. Se realizó una enterolitotomía y la paciente mostró un progreso posoperatorio favorable. En conclusión, es importante considerar la obstrucción intestinal inducida por íleo biliar en pacientes con síntomas relevantes y antecedentes médicos. Este reporte de caso subraya la importancia de considerar la obstrucción intestinal inducida por íleo biliar en pacientes con síntomas gastrointestinales y antecedentes de embarazo. El diagnóstico temprano y la intervención son cruciales para prevenir complicaciones graves.

ABSTRACT Gallstone ileus-induced intestinal obstruction is a rare but significant condition that occurs when a gallstone becomes lodged in the gastrointestinal tract. Major risk factors for gallstone ileus-induced intestinal obstruction include older age, female sex, diabetes, history of gallbladder disease such as gallstones, as well as previous gallbladder-related surgical procedures such as cholecystectomy. Pregnancy is also a known risk factor for gallstone disease. We present the case of a 38-year-old patient with a history of three cesarean sections and no apparent comorbidities. Prior to her visit to the emergency department, the patient experienced moderate colicky abdominal pain in the lower abdomen for two days. The physical examination revealed diffuse abdominal tenderness, predominantly in the right iliac fossa, along with signs of irritation of the peritoneum. Laboratory tests showed a leukocyte count of 11,490 cells/µl and neutrophilia of 85.6 %. Following an exploratory laparotomy, the suspected diagnosis of gallstone ileus was confirmed. An enterolithotomy was performed, and the patient experienced good post-surgical progress. In conclusion, it is important to consider gallstone ileus-induced intestinal obstruction among patients with relevant symptoms and medical history. This case report highlights the importance of considering gallstone ileus-induced intestinal obstruction among patients with gastrointestinal symptoms and a history of pregnancy. Early diagnosis and intervention are crucial to prevent serious complications.

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Immunoglobulin A (IgA) is an important factor in maintaining homeostasis at mucosal surfaces, yet luminal IgA levels vary widely. Total IgA levels are thought to be driven by individual immune responses to specific microbes. Here, we found that the prebiotic, pectin oligosaccharide (pec-oligo), induced high IgA levels in the small intestine in a T cell-dependent manner. Surprisingly, this IgA-high phenotype was retained after cessation of pec-oligo treatment, and microbiome transmission either horizontally or vertically was sufficient to retain high IgA levels in the absence of pec-oligo. Interestingly, the bacterial taxa enriched in the overall pec-oligo bacterial community differed from IgA-coated microbes in this same community. Rather, a group of ethanol-resistant microbes, highly enriched for Lachnospiraceae bacterium A2, drove the IgA-high phenotype. These findings support a model of intestinal adaptive immunity in which a limited number of microbes can promote durable changes in IgA directed to many symbionts.

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Introduction: Assessing ileal conduit for double J stents removal after radical cystectomy is not always a straightforward task as navigation inside the ileal loop can be challenging to manage due to the difficulty to maintain a waterfilled environment and its long and tortuous aspect. Methods: We present a novel technique using a flexible ureteroscope that aims to ease this common demand with simple and readily available tools. Results: This technique has been successfully utilized in 2 patients now. No complications were documented. Conclusion: We propose a novel surgical technique to improve endoscopic navigation in incontinent ileal loop urinary diversion.

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This study aimed to evaluate the effects of different dietary balanced protein (BP) levels on the gut health, amino acid apparent ileal digestibility (AID), footpad dermatitis lesions, and litter quality in broiler chicks infected with Eimeria maxima. A total of 2400 male 14-day-old Cobb500 broilers were randomly allotted into 10 treatments with six replications containing 40 birds each in a factorial design of 5 × 2. The treatments consisted of five levels of BP (6.66%, 13.32%, 19.98%, 26.64%, and 33.3%), and broilers unchallenged (NCH) or challenged (CH). Broilers in the CH group received 1 mL of Eimeria maxima inoculum (7 × 103 sporulated oocysts/mL). Oocyst count in excreta, visual intestinal modifications score, morphology, and morphometrics of the ileum were used to determine gut health status. Additionally, amino acids and CP AID, litter quality, and footpad dermatitis were evaluated. An ANOVA and Kruskal-Wallis tests followed by post-hoc tests were performed. The oocyst count in the CH group increased with an increase in dieatary BP (P = 0.08). The incidence of intestinal modifications was higher in the CH group (P < 0.05) and increased with increasing dietary BP (P < 0.05). Morphometrics were impaired by the challenge (P < 0.05), and by the two highest BP levels (P < 0.05). Amino acids AID (methionine, methionine + cystine, arginine, and serine) were reduced by E. maxima challenge. An increase in dietary BP resulted in poor litter quality and high prevalence of of footpad dermatitis (P < 0.05). The E. maxima challenge and increased BP decreased gut health, litter quality, and cause a high incidence of footpad dermatitis.

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La intususcepción ileocólica es una emergencia pediátrica con tratamiento inicial no quirúrgico a nivel mundial. La reducción hidrostática bajo guía ecográfica en pacientes pediátricos es un método de tratamiento inicial ampliamente utilizado en el mundo; sin embargo, en nuestro medio no se encuentra difundido su uso. Presentamos 4 casos de pacientes con intususcepción ileocólica tratados mediante enema hidrostático bajo guía ecográfica en el Instituto Nacional de Salud del Niño - San Borja (INSNSB), con reducción terapéutica y sin complicaciones.

Ileocolic intussusception is a pediatric emergency with initial non-surgical treatment. Ultrasound-guided hydrostatic reduction in pediatric patients is a widely used initial treatment method in the world; however, its use is not widespread in our environment. We present 4 cases of patients with ileocolic intussusception treated by ultrasound-guided hydrostatic reduction in the Instituto Nacional de Salud del Niño - San Borja (INSNSB), with therapeutic reduction and without complications.

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This study analyzed the effects of different dietary doses of encapsulated propyl propane thiosulfonate (Pe-PTSO) on the apparent ileal digestibility (AID) of nutrients and productive performance in broilers. A total of 100 one-day-old Cobb 500 were housed in battery cages for 20 days. At 10 days of age, the birds were assigned to one of five diets: negative control (P0), 250 mg/kg of Pe-PTSO (P250), 500 mg/kg of Pe-PTSO (P500), 750 mg/kg of Pe-PTSO (P750), and positive control, nicarbazin-narasin (ION). Titanium dioxide was the external marker, which was added to the diets from day 17 to 20. In the birds fed the P250 diet, there was a significant difference (p ≤ 0.05) in the AID values for amino acids and energy compared to those that consumed the P0 diet. Furthermore, the P250 diet significantly increased (p ≤ 0.05) the average daily weight gain compared to the P0 diet. No significant differences were observed between treatments in average daily feed intake and feed conversion ratio. In summary, the inclusion of 250 mg of encapsulated PTSO per kg in broiler chickens diet improved the digestibility of amino acids and energy, as well as weight gain.