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Of these, all but one initiated ART. Our ALCART system used existing CBPOs and contributed to >90% linkage-to-care and >99% ART-initiation among linked participants in a large, nationally-representative survey. This approach can be used to improve the potential benefits of HTS in other large population-based surveys.As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.[Figure see text].

Prescription opioids usage is on the rise. There has been an increasing recognition that chronic opioid consumption can result in esophageal motility disorders and this association has been named opioid-induced esophageal dysfunction (OIED).

Analyze the prevalence of chronic opioid consumption in patients referred for esophageal motility testing in a European center and to describe the clinical characteristics and the association of opioid consumption in esophageal motility disorders. METHODS Retrospective descriptive study in patients who had HRM performed in a single center. The clinical history in the electronic medical reports was reviewed. RESULTS The prevalence of opioid prescription in patients referred to our institution was 10.1% and 4.8% patients were on active chronic opioid use. We found a 32% prevalence of OIED. Comparing chronic active opioid user (CAOU) patients with OIED and CAOU patients without OIED, there was a higher prevalence of male sex (43.8% vs 8.8% p value=0.007). Converting the ription in patients referred to our institution was 10.1% and 4.8% patients were on active chronic opioid use. We found a 32% prevalence of OIED. Comparing chronic active opioid user (CAOU) patients with OIED and CAOU patients without OIED, there was a higher prevalence of male sex (43.8% vs 8.8% p value=0.007). Converting the different opioids medication to morphine milligram equivalent daily dose (MMED), CAOU patients with OIED had a higher MMED than CAOU patients without OIED (125.2±31.3 vs 33.4±5.7 MME p=0.041). Dysphagia was the most common indication for performing an HRM in 60.0% in CAOU patients. Furthermore, dysphagia was more frequent in CAOU patients with OIED (87.5% vs 47.0% p= 0.019). CONCLUSIONS Patients on chronic opioids with OIED complained mostly dysphagia. We found an association of male sex and a higher dose of opioids in CAOU patients with esophageal motility disorders.Mr. Editor, We have read with interest in your journal the article “Splenic rupture as an endoscopic complication as rare as it appears?” (1) and we would like to contribute a case handled in our hospital. Clinical case We present the case of a 72-year-old male smoker. His medical history showed a right lobectomy and adjuvant chemotherapy for lung adenocarcinoma. He was not under any kind of antiplatelet or anticoagulant medication. He had no history of abdominal surgery. An elective colonoscopy was performed with conscious sedation (midazolam and pethidine). The bowel preparation was appropriate. Diverticula and several pedunculated polyps were observed. After injection of diluted adrenaline (1/50000), a tubular adenoma with low-grade dysplasia measuring 20 millimeters in size was successfully removed using a diathermic loop at the splenic flexure. check details Post-resection mucosal defect was closed prophylactically with clip. 24 horas later, the patient was admitted to the emergency department due to abdominal pain aninal X-ray is negative (2). The treatment of choice is urgent surgery (3,4,5) when there is hemodynamic instability. This complication has been described as very rare, with an incidence of 0.004% (4). Interestingly the cases presented here and before (1,4) suggest that the incidence of this complication could be higher.The authors report an unusual case of gastrointestinal bleeding with a challenging diagnosis, associated with a Bochdalek hernia. This clinical case highlights the role of capsule endoscopy both as a first-line exam in obscure gastrointestinal bleeding and as an alternative exam in cases of incomplete colonoscopy.  .Magnets ingestion in children is not rare and pose a high risk of severe complications. Herein, we presented a case of pediatric magnets ingestion in which magnets were separately lodged in the lower esophagus and cardia. An innovative endoscopic removal technique using forceps was successful in treating this complicated case.17 year old female teenager with abdominal pain secondary to pelvic mass of 12 x 10 cm, which seems to depend on ovary. Surgery is scheduled for removal of the tumor, during which it is observed that the lesion originates in the ileum. The histopathological study shows a neoplasm of small round cells with nucleoli and scant cytoplasm. The tumor cells are immunoreactive to CD99 and ERG, being negative for cytokeratins, FLI1, WT1, DOG1 and lymphoid markers. By means of FISH, a rearrangement of the EWSR1 gene was demonstrated. By integrating these molecular and immunohistochemical findings with the morphology, it was diagnosed as Ewing’s sarcoma. This aggressive and infrequent tumor originates from neuroectodermal cells and usually develops in the long bones of pediatric and young adult patients, although exceptionally it can occur in other locations. At the intestinal level, it mainly affects the ileum, with a non-specific pain and fatigue clinic. The treatment of choice is surgery for resection of the affected loop, followed by chemotherapy.