Risk factors for anastomotic leakage following total or subtotal colectomy

Introduction: A higher rate of anastomotic leakage (AL) is reported after ileosigmoid anastomosis (ISA) or ileorectal anastomosis (IRA) in total or subtotal colectomy (TSC) compared with colonic or colorectal anastomosis. Themain aimof the present studywas to assess potential risk factors for AL after ISA or IRA and to investigate determinants of morbidity. Methods: We identified 180 consecutive patients in a prospective referral, single center database, in which 83 of the patients underwent TSC with ISA or IRA. Data regarding the clinical characteristics, surgical treatment, and outcome were assessed to determine their association with the cumulative incidence of AL and surgical morbidity. Results: Ileosigmoid anastomosis was performed in 51 of the patients (61.5%) and IRA in 32 patients (38.6%). The cumulative incidence of ALwas 15.6% (13 of 83 patients). A higher AL rate was found in patients under 50 years-old (p=0.038), in the electivelaparoscopic approach subgroup (p=0.049), and patients in the inflammatory bowel disease (IBD) subgroup (p=0.009). Furthermore, 14 patients (16.9%) had morbidity classified as Clavien-Dindo ≥ IIIA. Discussion: A relatively high incidence of AL after TSC was observed in a relatively safe surgical procedure. Our findings suggest that the risk of AL may be higher in IBD patients. According to our results, identifying risk factors prior to surgerymay improve short-term outcomes. (AU)

Mycobacterium tuberculosis: espoligotipos en el Estado Carabobo, Venezuela / Mycobacterium tuberculosis: spoligotypes in the Carabobo State, Venezuela

In order to study the genetic variability oí Mycobacterium tuberculosis circulating in the Carabobo State at Venezuela, 317 strains of M. tuberculosis isolated from patients living in different health districts whose acid fast smears were positive, were included. Each strain was characterized by spoligotyping and the pattern compared with the national and worldwide SpolDB4.0 databases; 220 isolates (69.4 percent) were grouped in 24 clusters, being LAM the most common family (34 percent). In contrast to other Venezuelan regions, the most common Carabobo spoligotype was number 605, with 46 isolates (14.5 percent). In addition, there were 97 (30.6 percent) orphan spoligotypes, 19 of which are found in SpolDB4.0, and 78 non described. Co-infection with human irnmunodeficiency virus was detected in 11 patients (3.5 percent). These results show high genotypic variability of M. tuberculosis in the región, contributing with new information for a better understanding of tuberculosis transmission in Venezuela.

Con el objeto de estudiar la variabilidad genética de las cepas de Mycobacterium tuberculosis circulantes en el Estado Carabobo, Venezuela, se empleó la técnica de spoligotyping para caracterizar 317 cepas de M. tuberculosis aisladas de pacientes con baciloscopia y cultivo positivo, residentes en diferentes distritos sanitarios. Los espoligotipos obtenidos se contrastaron con la base de datos nacional y mundial (SpolDB4.0); 220 aislados (69,4 por ciento) se agruparon en 24 clusters, con predominio de la familia LAM (34 por ciento). A diferencia de otras regiones venezolanas, el espoligotipo 605 fue el más frecuente con 46 aislados (14,5 por ciento). Se identificaron 97 (30,6 por cientoo) aislados únicos, 19 reportados en SpolDB4.0 y 78 no descritos. Co-infección con el virus de inmunodeficiencia humana se detectó en 11 pacientes (3,5 por cientoo). Los resultados son un aporte al estudio de la transmisión de la tuberculosis a nivel regional y nacional y sugieren que existen diferencias regionales en las cepas más comunes. La cepa 605, poco común fuera de Venezuela, requiere de estudios epidemiológicos adicionales.