Abigail Garcia - Academia.edu (original) (raw)
Papers by Abigail Garcia
Pathogens, 2021
Sepsis, resulting from a dysregulated host immune response to invading pathogens, is the leading ... more Sepsis, resulting from a dysregulated host immune response to invading pathogens, is the leading cause of mortality in critically ill patients worldwide. Immunomodulatory treatment for sepsis is currently lacking. Children with short bowel syndrome (SBS) may present with less severe symptoms during gram-negative bacteremia. We, therefore, tested the hypothesis that plasma from children with SBS could confer protection against Escherichia coli sepsis. We showed that SBS plasma at 5% and 10% concentrations significantly (p < 0.05) inhibited the production of both TNF-α and IL-6 induced by either E. coli- or LPS-stimulated host cells when compared to plasma from healthy controls. Furthermore, mice treated intravenously with select plasma samples from SBS or healthy subjects had reduced proinflammatory cytokine levels in plasma and a significant survival advantage after E. coli infection. However, SBS plasma was not more protective than the plasma of healthy subjects, suggesting that...
The hypoglycemic action of both Smallanthus sonchifolius (Yacon) and Stevia rebaudiana (Stevia) e... more The hypoglycemic action of both Smallanthus sonchifolius (Yacon) and Stevia rebaudiana (Stevia) ethanolic leaf extracts diluted in 0.85% Normal saline solution (NSS) were examined in streptozotocin (STZ) induced mice. The ethanolic leaf extracts’ hypoglycemic effect was compared with the drug Metformin. Other parameters such as body weight, food consumption, and water intake were also examined to further support the findings. Analysis of variance was done to the data gathered for blood glucose level, body weight, food consumption, and water intake; all suggested a significant difference. The calculated F-value for the blood glucose level is 16.875, which is greater than the critical value of F 0.05 = 2.69. The null hypothesis was rejected and concluded that there is a significant difference between the treatment groups and control groups. Tukey’s test was done to further determine the difference. It was found that Stevia rebaudiana was comparable to the drug Metformin. While the lea...
The aphid Chaetosiphon fragaefolii Cockerell, 1901 is an agricultural pest and known vector of st... more The aphid Chaetosiphon fragaefolii Cockerell, 1901 is an agricultural pest and known vector of strawberry viruses. To better understand its biology and systematics, we performed a genomic analysis on C. fragaefolii collected from Quinalt strawberry plants from Pacific Grove, Monterey county, California, USA using Oxford Nanopore and Illumina sequencing. The resulting data were used to assemble the aphids complete mitogenome. The mitogenome of C. fragaefolii is 16,108 bp in length and contains 2 rRNA, 13 protein-coding, and 22 tRNA genes (GenBank accession number LC590896). The mitogenome is similar in content and organization to other Aphididae. Phylogenetic analysis of the C. fragaefolii mitogenome resolved it in a fully supported clade in the tribe Macrosiphini. Analysis of the cox1 barcode sequence of C. fragaefolii from California found exact and nearly identical sequences to C. fragaefolii and Chaetosiphon thomasi Hille Ris Lambers, 1953, suggesting the two species are conspeci...
Revista Medicina Universitaria
Introduction: Pain assessment in non-verbal patients during medical interventions can be challeng... more Introduction: Pain assessment in non-verbal patients during medical interventions can be challenging due to communication problems. Therefore, it is necessary to use new pain measurement tools for these patients. Objective: The objective of the study was to assess the incidence of pain in patients with cerebral palsy (CP) and autism spectrum disorder (ASD) who undergo bone marrow aspiration (BMA) and lumbar puncture (LP) for cell therapy. Methods: The "Non-Communicating Children's Pain Checklist-Revised" checklist was used to observe the behavior of 15 patients diagnosed with CP and ASD before and after cell therapy. The evaluation was carried out simultaneously by a caregiver and by the staff of the medical team on three occasions. Scores ≥ 7 were considered as the presence of moderate or severe pain. Results: Regarding the scores obtained in the second survey (30 min after the BMA and LP), the caregivers reported values of < 7 points in 10 patients (66.7%). At the same time, in the evaluation performed by caregivers 24 h after the procedure, scores of < 7 points were reported in eight (53.3%). The items with the highest scores in the surveys were verbal and facial expressions, social attitudes, and activities. Conclusions: The procedures carried out in cell therapy were safe and well-tolerated by this group of patients, with an incidence of pain in only 33.3%, which can be considered a therapeutic alternative to improve their current condition without compromising their integrity or quality of life.
Advances in Orthopedics
Background. Additional studies on clinical outcomes to determine the optimal time delay from inje... more Background. Additional studies on clinical outcomes to determine the optimal time delay from injection of local anesthesia to skin incision for WALANT surgeries are needed. The authors aimed to propose the optimal time delay from local injection to skin incision for WALANT surgeries of the hand and wrist by analyzing intraoperative blood loss, postoperative pain scores, and complication rates. Methods. Thirty-four patients were consecutively recruited and allocated by either 7-min or 30-min delay for skin incision from local injection of epinephrine with lidocaine. Intraoperative bleeding and postoperative pain scores were analyzed between both groups by Mann–Whitney U-test, while complication rates were compared using Fisher’s exact test. Results. The present study did not find significant differences in mean intraoperative blood loss (8 ± 5.8 mL vs. 5 ± 2.2 mL, p=0.074), complication rates (18% vs. 0%, p=0.227), and mean pain scores (1.2 ± 0.5 vs. 1.4 ± 0.5, p=0.307) between the 7...
Journal of Medical Entomology
Ixodids (hard ticks) ingest blood from host animals, and they can transmit pathogenic organisms t... more Ixodids (hard ticks) ingest blood from host animals, and they can transmit pathogenic organisms that induce medical and veterinary diseases. As resistance to synthetic conventional acaricides becomes more common, alternative tactics are coming under heightened scrutiny. Laboratory bioassays were used to assess the efficacy of CimeXa, a commercially available silica gel desiccant dust product, and Drione, a commercial product containing silica gel + pyrethrins and a synergist, piperonyl butoxide, against lone star tick, Amblyomma americanum (L.) (Ixodida: Ixodidae), larvae and nymphs. Both life stages were completely killed by CimeXa by 24 h, and Drione caused total larval mortality within 1 h when they were briefly immersed in the dusts and when they crawled across dust-treated substrate; nymphs were completely killed by 4 h after the same kinds of exposure. Mortality of A. americanum larvae and nymphs occurred after the pests crawled across dried aqueous suspensions of the products...
Biology of Blood and Marrow Transplantation
Liver Research
Abstract Alcoholic liver disease (ALD) remains one of the leading causes of liver injury and deat... more Abstract Alcoholic liver disease (ALD) remains one of the leading causes of liver injury and death when left untreated. The gut microbiota has been recognized as a key regulator of a number of pathologies, including ALD. The role of mast cells (MCs) during liver disease progression has been demonstrated in a number of animal models and in human liver diseases. The interaction between the gut microbiota and MCs has been investigated, and links between the gut and these immune cells are being uncovered. The interplay between the gut microbiota and MCs during ALD has been evaluated and studies suggest that there could be an important link between MCs, their mediators and gut inflammation during the progression of ALD.
BMC Psychology
Background: While it is commonly understood that a cancer diagnosis evokes feelings of fear, the ... more Background: While it is commonly understood that a cancer diagnosis evokes feelings of fear, the effect of labeling a child's illness as "cancer" remains unstudied. We hypothesized that lower health utility scores would be assigned to disease states labeled as cancer compared to identical disease states without the mention of cancer. Methods: In this randomized study, caregivers of healthy children were asked to assign health utility values to different scenarios written as improving, stable, or worsening. Participants from general pediatric clinics at Eskenazi Health were randomly assigned to either the scenarios labeled as "cancer" or "a serious illness". Participants then rated the scenarios using the Standard Gamble, with laddering of health utilities between 0 (a painless death) and 1 (perfect health). We also gathered subject demographics and assessed the subject's numeracy. Results: We approached 319 subjects and 167 completed the study. Overall median health utilities of "cancer" scenarios were lower than "serious illness" scenarios (0.61 vs. 0.72, p = 0.018). Multivariate regression (with an outcome of having a utility above the 75th percentile) showed no significant effects by race, ethnicity, numeracy, or income level. "Cancer" scenarios remained significantly lower after adjustment for confounders using logistic regression, but only for the more serious scenarios (OR 0.92, p = 0.048). Conclusions: On average, caregivers with healthy children were shown to take more risk with their treatment options and view their child as having a worse quality of life when they knew the disease was cancer. Awareness of this bias is important when discussing treatments with families, particularly when a risk of cancer is present.
Uno de los principales objetivos de los educadores físicos es promover la participación a largo p... more Uno de los principales objetivos de los educadores físicos es promover la participación a largo plazo de la actividad física en el tiempo libre. Uno de los enfoques utlizados para cumplir este propósito es el Modelo Transteorico, el cual utiliza el concepto de la etapas de cambio para conocer el estado en el que se encuentran las personas respecto a la realización de ejercicio y cuándo se está produciendo un cambio en el comportamiento. El presente estudio se desarrolló en la población mayor de 15 años de la ciudad de Monterrey (México). La muestra estuvo compuesta por 1,118 sujetos. El procedimiento de muestreo fue polietápico con afijación proporcional, utilizando el tipo de muestreo aleatorio estratificado y por conglomerados. Los resultados revelaron que las clases divertidas pueden llegar a generar al menos la intención de tener un estilo de vida activo y disminuir el sedentarismo. Cuando el tiempo de clase de EF es bien aprovechado favorece la creación de hábitos de ejercicio,...
MOJ Orthopedics & Rheumatology, 2014
Background: The care of compartment syndrome fasciotomy & open fracture II, IIIA & IIIB wounds be... more Background: The care of compartment syndrome fasciotomy & open fracture II, IIIA & IIIB wounds begin with preoperative planning. The ultimate goal is to prevent infection & facilitate healing. This study explores the use of plastic bands in closing fasciotomy wounds & open fracture. Methods: The time to definite closure, complications, need for additional intervention, length of hospital stay and daily treatment cost in 10 patients were evaluated. Five patients with fasciotomy wounds & five patients with open fractures treated with plastic bands for wound closure were evaluated. Result: All fasciotomy wounds & open fracture wounds in 10 patients closed successfully within 5-10 days. Only one patient developed minimal complication. A significant reduction in hospital stay, faster wound closure and lower daily treatment cost was observed. Conclusion: This observational study demonstrated that the plastic band method used is cheaper, reliable and effective method in closure of fasciotomy wounds & open fracture in comparison to similar techniques using the same device.
The Journal of Physiology, 2013
is required for gel-forming mucins to form normal mucus, but how? • Two apparently separate signa... more is required for gel-forming mucins to form normal mucus, but how? • Two apparently separate signalling pathways are activated concurrently to bring mucus formation to completion: a Ca 2+-mediated pathway mainly directs goblet cell exocytosis, and an independent cAMP-mediated pathway stimulates HCO 3 − secretion to help discharge exocytosed mucus. • cAMP-dependent HCO 3 − secretion fails, disrupting the normal formation and discharge of mucins in cystic fibrosis (CF) leading to pathologically viscous and tenacious mucus in affected organs. • This work advances our understanding of the role of cAMP (CFTR)-dependent HCO 3 − secretion in forming normal mucus and underscores a new importance of addressing the defect in HCO 3 − secretion as a critical new therapeutic target in CF.
Journal of Pediatric Gastroenterology and Nutrition, 2009
Williams syndrome (WS) is a rare multisystemic disorder characterized by distinctive facial featu... more Williams syndrome (WS) is a rare multisystemic disorder characterized by distinctive facial features, mental retardation or learning difficulties, a unique cognitive and personality profile, infantile hypercalcemia, cardiovascular disease, and connective tissue abnormalities. The estimated prevalence of WS is 1 in 7500 live births. Gastrointestinal symptoms such as chronic abdominal pain, feeding problems, constipation, and gastroesophageal reflux disease are seen relatively frequently in children with WS (1). Among adults with WS, colonic diverticulosis has been reported with a frequency of 8% to 12% (2,3). By contrast, among children with WS, only 1 case of diverticular disease has been reported: in a 17-year-old boy. We report what we believe to be the youngest patient with WS with complicated colonic diverticular disease. A 13-year-old boy with WS with mild supravalvular aortic stenosis, ventricular septal disease without requirement for surgical correction, hypertension, and developmental delay was brought to the gastroenterology clinic having experienced intermittent abdominal pain for the previous 2 years. The abdominal pain was crampy, localized to the periumbilical area, and accompanied by nausea, decreased appetite, nonbloody diarrhea, and elevated temperature to 38.58C. He did not report any urinary symptoms. Each episode lasted from a few hours to several days and occurred at least once per month. Before being seen by this group of physicians, the patient had been seen several times in the emergency
Pathogens, 2021
Sepsis, resulting from a dysregulated host immune response to invading pathogens, is the leading ... more Sepsis, resulting from a dysregulated host immune response to invading pathogens, is the leading cause of mortality in critically ill patients worldwide. Immunomodulatory treatment for sepsis is currently lacking. Children with short bowel syndrome (SBS) may present with less severe symptoms during gram-negative bacteremia. We, therefore, tested the hypothesis that plasma from children with SBS could confer protection against Escherichia coli sepsis. We showed that SBS plasma at 5% and 10% concentrations significantly (p < 0.05) inhibited the production of both TNF-α and IL-6 induced by either E. coli- or LPS-stimulated host cells when compared to plasma from healthy controls. Furthermore, mice treated intravenously with select plasma samples from SBS or healthy subjects had reduced proinflammatory cytokine levels in plasma and a significant survival advantage after E. coli infection. However, SBS plasma was not more protective than the plasma of healthy subjects, suggesting that...
The hypoglycemic action of both Smallanthus sonchifolius (Yacon) and Stevia rebaudiana (Stevia) e... more The hypoglycemic action of both Smallanthus sonchifolius (Yacon) and Stevia rebaudiana (Stevia) ethanolic leaf extracts diluted in 0.85% Normal saline solution (NSS) were examined in streptozotocin (STZ) induced mice. The ethanolic leaf extracts’ hypoglycemic effect was compared with the drug Metformin. Other parameters such as body weight, food consumption, and water intake were also examined to further support the findings. Analysis of variance was done to the data gathered for blood glucose level, body weight, food consumption, and water intake; all suggested a significant difference. The calculated F-value for the blood glucose level is 16.875, which is greater than the critical value of F 0.05 = 2.69. The null hypothesis was rejected and concluded that there is a significant difference between the treatment groups and control groups. Tukey’s test was done to further determine the difference. It was found that Stevia rebaudiana was comparable to the drug Metformin. While the lea...
The aphid Chaetosiphon fragaefolii Cockerell, 1901 is an agricultural pest and known vector of st... more The aphid Chaetosiphon fragaefolii Cockerell, 1901 is an agricultural pest and known vector of strawberry viruses. To better understand its biology and systematics, we performed a genomic analysis on C. fragaefolii collected from Quinalt strawberry plants from Pacific Grove, Monterey county, California, USA using Oxford Nanopore and Illumina sequencing. The resulting data were used to assemble the aphids complete mitogenome. The mitogenome of C. fragaefolii is 16,108 bp in length and contains 2 rRNA, 13 protein-coding, and 22 tRNA genes (GenBank accession number LC590896). The mitogenome is similar in content and organization to other Aphididae. Phylogenetic analysis of the C. fragaefolii mitogenome resolved it in a fully supported clade in the tribe Macrosiphini. Analysis of the cox1 barcode sequence of C. fragaefolii from California found exact and nearly identical sequences to C. fragaefolii and Chaetosiphon thomasi Hille Ris Lambers, 1953, suggesting the two species are conspeci...
Revista Medicina Universitaria
Introduction: Pain assessment in non-verbal patients during medical interventions can be challeng... more Introduction: Pain assessment in non-verbal patients during medical interventions can be challenging due to communication problems. Therefore, it is necessary to use new pain measurement tools for these patients. Objective: The objective of the study was to assess the incidence of pain in patients with cerebral palsy (CP) and autism spectrum disorder (ASD) who undergo bone marrow aspiration (BMA) and lumbar puncture (LP) for cell therapy. Methods: The "Non-Communicating Children's Pain Checklist-Revised" checklist was used to observe the behavior of 15 patients diagnosed with CP and ASD before and after cell therapy. The evaluation was carried out simultaneously by a caregiver and by the staff of the medical team on three occasions. Scores ≥ 7 were considered as the presence of moderate or severe pain. Results: Regarding the scores obtained in the second survey (30 min after the BMA and LP), the caregivers reported values of < 7 points in 10 patients (66.7%). At the same time, in the evaluation performed by caregivers 24 h after the procedure, scores of < 7 points were reported in eight (53.3%). The items with the highest scores in the surveys were verbal and facial expressions, social attitudes, and activities. Conclusions: The procedures carried out in cell therapy were safe and well-tolerated by this group of patients, with an incidence of pain in only 33.3%, which can be considered a therapeutic alternative to improve their current condition without compromising their integrity or quality of life.
Advances in Orthopedics
Background. Additional studies on clinical outcomes to determine the optimal time delay from inje... more Background. Additional studies on clinical outcomes to determine the optimal time delay from injection of local anesthesia to skin incision for WALANT surgeries are needed. The authors aimed to propose the optimal time delay from local injection to skin incision for WALANT surgeries of the hand and wrist by analyzing intraoperative blood loss, postoperative pain scores, and complication rates. Methods. Thirty-four patients were consecutively recruited and allocated by either 7-min or 30-min delay for skin incision from local injection of epinephrine with lidocaine. Intraoperative bleeding and postoperative pain scores were analyzed between both groups by Mann–Whitney U-test, while complication rates were compared using Fisher’s exact test. Results. The present study did not find significant differences in mean intraoperative blood loss (8 ± 5.8 mL vs. 5 ± 2.2 mL, p=0.074), complication rates (18% vs. 0%, p=0.227), and mean pain scores (1.2 ± 0.5 vs. 1.4 ± 0.5, p=0.307) between the 7...
Journal of Medical Entomology
Ixodids (hard ticks) ingest blood from host animals, and they can transmit pathogenic organisms t... more Ixodids (hard ticks) ingest blood from host animals, and they can transmit pathogenic organisms that induce medical and veterinary diseases. As resistance to synthetic conventional acaricides becomes more common, alternative tactics are coming under heightened scrutiny. Laboratory bioassays were used to assess the efficacy of CimeXa, a commercially available silica gel desiccant dust product, and Drione, a commercial product containing silica gel + pyrethrins and a synergist, piperonyl butoxide, against lone star tick, Amblyomma americanum (L.) (Ixodida: Ixodidae), larvae and nymphs. Both life stages were completely killed by CimeXa by 24 h, and Drione caused total larval mortality within 1 h when they were briefly immersed in the dusts and when they crawled across dust-treated substrate; nymphs were completely killed by 4 h after the same kinds of exposure. Mortality of A. americanum larvae and nymphs occurred after the pests crawled across dried aqueous suspensions of the products...
Biology of Blood and Marrow Transplantation
Liver Research
Abstract Alcoholic liver disease (ALD) remains one of the leading causes of liver injury and deat... more Abstract Alcoholic liver disease (ALD) remains one of the leading causes of liver injury and death when left untreated. The gut microbiota has been recognized as a key regulator of a number of pathologies, including ALD. The role of mast cells (MCs) during liver disease progression has been demonstrated in a number of animal models and in human liver diseases. The interaction between the gut microbiota and MCs has been investigated, and links between the gut and these immune cells are being uncovered. The interplay between the gut microbiota and MCs during ALD has been evaluated and studies suggest that there could be an important link between MCs, their mediators and gut inflammation during the progression of ALD.
BMC Psychology
Background: While it is commonly understood that a cancer diagnosis evokes feelings of fear, the ... more Background: While it is commonly understood that a cancer diagnosis evokes feelings of fear, the effect of labeling a child's illness as "cancer" remains unstudied. We hypothesized that lower health utility scores would be assigned to disease states labeled as cancer compared to identical disease states without the mention of cancer. Methods: In this randomized study, caregivers of healthy children were asked to assign health utility values to different scenarios written as improving, stable, or worsening. Participants from general pediatric clinics at Eskenazi Health were randomly assigned to either the scenarios labeled as "cancer" or "a serious illness". Participants then rated the scenarios using the Standard Gamble, with laddering of health utilities between 0 (a painless death) and 1 (perfect health). We also gathered subject demographics and assessed the subject's numeracy. Results: We approached 319 subjects and 167 completed the study. Overall median health utilities of "cancer" scenarios were lower than "serious illness" scenarios (0.61 vs. 0.72, p = 0.018). Multivariate regression (with an outcome of having a utility above the 75th percentile) showed no significant effects by race, ethnicity, numeracy, or income level. "Cancer" scenarios remained significantly lower after adjustment for confounders using logistic regression, but only for the more serious scenarios (OR 0.92, p = 0.048). Conclusions: On average, caregivers with healthy children were shown to take more risk with their treatment options and view their child as having a worse quality of life when they knew the disease was cancer. Awareness of this bias is important when discussing treatments with families, particularly when a risk of cancer is present.
Uno de los principales objetivos de los educadores físicos es promover la participación a largo p... more Uno de los principales objetivos de los educadores físicos es promover la participación a largo plazo de la actividad física en el tiempo libre. Uno de los enfoques utlizados para cumplir este propósito es el Modelo Transteorico, el cual utiliza el concepto de la etapas de cambio para conocer el estado en el que se encuentran las personas respecto a la realización de ejercicio y cuándo se está produciendo un cambio en el comportamiento. El presente estudio se desarrolló en la población mayor de 15 años de la ciudad de Monterrey (México). La muestra estuvo compuesta por 1,118 sujetos. El procedimiento de muestreo fue polietápico con afijación proporcional, utilizando el tipo de muestreo aleatorio estratificado y por conglomerados. Los resultados revelaron que las clases divertidas pueden llegar a generar al menos la intención de tener un estilo de vida activo y disminuir el sedentarismo. Cuando el tiempo de clase de EF es bien aprovechado favorece la creación de hábitos de ejercicio,...
MOJ Orthopedics & Rheumatology, 2014
Background: The care of compartment syndrome fasciotomy & open fracture II, IIIA & IIIB wounds be... more Background: The care of compartment syndrome fasciotomy & open fracture II, IIIA & IIIB wounds begin with preoperative planning. The ultimate goal is to prevent infection & facilitate healing. This study explores the use of plastic bands in closing fasciotomy wounds & open fracture. Methods: The time to definite closure, complications, need for additional intervention, length of hospital stay and daily treatment cost in 10 patients were evaluated. Five patients with fasciotomy wounds & five patients with open fractures treated with plastic bands for wound closure were evaluated. Result: All fasciotomy wounds & open fracture wounds in 10 patients closed successfully within 5-10 days. Only one patient developed minimal complication. A significant reduction in hospital stay, faster wound closure and lower daily treatment cost was observed. Conclusion: This observational study demonstrated that the plastic band method used is cheaper, reliable and effective method in closure of fasciotomy wounds & open fracture in comparison to similar techniques using the same device.
The Journal of Physiology, 2013
is required for gel-forming mucins to form normal mucus, but how? • Two apparently separate signa... more is required for gel-forming mucins to form normal mucus, but how? • Two apparently separate signalling pathways are activated concurrently to bring mucus formation to completion: a Ca 2+-mediated pathway mainly directs goblet cell exocytosis, and an independent cAMP-mediated pathway stimulates HCO 3 − secretion to help discharge exocytosed mucus. • cAMP-dependent HCO 3 − secretion fails, disrupting the normal formation and discharge of mucins in cystic fibrosis (CF) leading to pathologically viscous and tenacious mucus in affected organs. • This work advances our understanding of the role of cAMP (CFTR)-dependent HCO 3 − secretion in forming normal mucus and underscores a new importance of addressing the defect in HCO 3 − secretion as a critical new therapeutic target in CF.
Journal of Pediatric Gastroenterology and Nutrition, 2009
Williams syndrome (WS) is a rare multisystemic disorder characterized by distinctive facial featu... more Williams syndrome (WS) is a rare multisystemic disorder characterized by distinctive facial features, mental retardation or learning difficulties, a unique cognitive and personality profile, infantile hypercalcemia, cardiovascular disease, and connective tissue abnormalities. The estimated prevalence of WS is 1 in 7500 live births. Gastrointestinal symptoms such as chronic abdominal pain, feeding problems, constipation, and gastroesophageal reflux disease are seen relatively frequently in children with WS (1). Among adults with WS, colonic diverticulosis has been reported with a frequency of 8% to 12% (2,3). By contrast, among children with WS, only 1 case of diverticular disease has been reported: in a 17-year-old boy. We report what we believe to be the youngest patient with WS with complicated colonic diverticular disease. A 13-year-old boy with WS with mild supravalvular aortic stenosis, ventricular septal disease without requirement for surgical correction, hypertension, and developmental delay was brought to the gastroenterology clinic having experienced intermittent abdominal pain for the previous 2 years. The abdominal pain was crampy, localized to the periumbilical area, and accompanied by nausea, decreased appetite, nonbloody diarrhea, and elevated temperature to 38.58C. He did not report any urinary symptoms. Each episode lasted from a few hours to several days and occurred at least once per month. Before being seen by this group of physicians, the patient had been seen several times in the emergency