Investigating inhibitors of 1-deoxy-d-xylulose 5-phosphate synthase in a mouse model of UTI.

The rising rate of antimicrobial resistance continues to threaten global public health. Further hastening antimicrobial resistance is the lack of new antibiotics against new targets. The bacterial enzyme, 1-deoxy-d-xylulose 5-phosphate synthase (DXPS), is thought to play important roles in central metabolism, including processes required for pathogen adaptation to fluctuating host environments. Thus, impairing DXPS function represents a possible new antibacterial strategy. We previously investigated a DXPS-dependent metabolic adaptation as a potential target in uropathogenic Escherichia coli (UPEC) associated with urinary tract infection (UTI), using the DXPS-selective inhibitor butyl acetylphosphonate (BAP). However, investigations of DXPS inhibitors in vivo have not been conducted. The goal of the present study is to advance DXPS inhibitors as in vivo probes and assess the potential of inhibiting DXPS as a strategy to prevent UTI in vivo. We show that BAP was well-tolerated at high doses in mice and displayed a favorable pharmacokinetic profile for studies in a mouse model of UTI. Further, an alkyl acetylphosphonate prodrug (homopropargyl acetylphosphonate, pro-hpAP) was significantly more potent against UPEC in urine culture and exhibited good exposure in the urinary tract after systemic dosing. Prophylactic treatment with either BAP or pro-hpAP led to a partial protective effect against UTI, with the prodrug displaying improved efficacy compared to BAP. Overall, our results highlight the potential for DXPS inhibitors as in vivo probes and establish preliminary evidence that inhibiting DXPS impairs UPEC colonization in a mouse model of UTI.IMPORTANCENew antibiotics against new targets are needed to prevent an antimicrobial resistance crisis. Unfortunately, antibiotic discovery has slowed, and many newly FDA-approved antibiotics do not inhibit new targets. Alkyl acetylphosphonates (alkyl APs), which inhibit the enzyme 1-deoxy-d-xylulose 5-phosphate synthase (DXPS), represent a new possible class of compounds as there are no FDA-approved DXPS inhibitors. To our knowledge, this is the first study demonstrating the in vivo safety, pharmacokinetics, and efficacy of alkyl APs in a urinary tract infection mouse model.

Enhancing Wound Healing: A Novel Topical Emulsion Combining CW49 Peptide and Lavender Essential Oil for Accelerated Regeneration and Antibacterial Protection.

Wound healing is a complex process involving blood cells, extracellular matrix, and parenchymal cells. Research on biomimetics in amphibian skin has identified the CW49 peptide from Odorrana grahami, which has been demonstrated to promote wound regeneration. Additionally, lavender essential oil exhibits anti-inflammatory and antibacterial activities. Given these considerations, we propose an innovative emulsion that combines the CW49 peptide with lavender oil. This novel formulation could serve as a potent topical treatment, potentially fostering the regeneration of damaged tissues and providing robust antibacterial protection for skin wounds. This study investigates the physicochemical properties, biocompatibility, and in vitro regenerative capacity of the active components and the emulsion. The results show that the emulsion possesses appropriate rheological characteristics for topical application. Both the CW49 peptide and lavender oil exhibit high viability in human keratinocytes, indicating their biocompatibility. The emulsion induces hemolysis and platelet aggregation, an expected behavior for such topical treatments. Furthermore, the lavender-oil emulsion demonstrates antibacterial activity against both Gram-positive and Gram-negative bacterial strains. Finally, the regenerative potential of the emulsion and its active components is confirmed in a 2D wound model using human keratinocytes. In conclusion, the formulated emulsion, which combines the CW49 peptide and lavender oil, shows great promise as a topical treatment for wound healing. Further research is needed to validate these findings in more advanced in vitro models and in vivo settings, potentially leading to improved wound-care management and novel therapeutic options for patients with skin injuries.

Conocimientos y actitudes sobre interrupción voluntaria del embarazo en estudiantes de una Universidad de Cartagena (Colombia) / Knowledge and attitudes regarding interruption of pregnancy in students of a University in Cartagena (Colombia)

Introducción: La interrupción voluntaria del embarazo es un asunto político que polariza las opiniones y genera controversias entre el sector salud, social, económico y cultural. Objetivo: Determinar el nivel de conocimiento y actitudes sobre la interrupción voluntaria del embarazo en estudiantes de dos programas de Ciencias de la Salud de Cartagena. Materiales y métodos: Estudio descriptivo transversal, se aplicó el cuestionario adaptado por Marceliano y Medrano a 231 estudiantes de Enfermería y Medicina, los datos se analizaron obteniendo frecuencias relativas y absolutas. Resultados: El nivel de conocimiento de los estudiantes fue alto con 92,20% (213). Sin embargo, el 37,2% (86) no sabía cuáles eran las tres causales para que el aborto no se considere un delito. El 56,7% asume actitudes negativas hacia firmar una petición para legalizar el aborto y el 18,8% considera que si una mujer se realiza un aborto debe ir a la cárcel. Conclusión: El nivel de conocimiento de los estudiantes de medicina y enfermería es alto, sin embargo, los patrones muestran desconocimiento sobre las causales de legalización del aborto de acuerdo con la norma vigente y una variabilidad de actitudes positivas y negativas ante la interrupción voluntaria del embarazo.

Introduction: Voluntary interruption of pregnancy is a political issue that polarizes opinions and generates controversy within the health, social, economic, and cultural sectors. Objective: To determine the level of knowledge and attitudes regarding voluntary interruption of pregnancy in university students from two Health Sciences programs of Cartagena. Materials and methods: A descriptive cross-sectional study; the questionnaire adapted by Marceliano and Medrano was given to 231 students within the Nursing and Medical programs; the data was analyzed through relative and absolute frequencies. Results: The level of knowledge of the students was high with a 92.20% (213). Yet, a 37.2% (86) did not know the three reasons why abortion is not considered a crime. 56.7% have negative attitudes regarding signing a petition to legalize abortion and an 18.8% believe that a woman who has an abortion should go to jail. Conclusion: The level of knowledge in medical and nursing students is high, yet the patterns show lack of knowledge of the reasons for legalization of abortion according to the current laws and a variety of positive and negative attitudes regarding the voluntary interruption of pregnancy.

Pre-Germinative Treatments and Morphophysiological Traits in Enterolobium cyclocarpum and Piscidia piscipula (Fabaceae) from the Yucatan Peninsula, Mexico.

Enterolobium cyclocarpum and Piscidia piscipula are two important tree Fabaceae species distributed from the Yucatan Peninsula, Mexico. Our aims were focused on the E. cyclocarpum and P. piscipula seeds for: (1) to examine the seed permeability and imbibition rate, (2) to evaluate the effect of seed pre-germinative treatments, and (3) to characterize the structures involved on the presence of physical dormancy (PY). We used fresh seeds to determine seed permeability and imbibition rate, seed viability by means of tetrazolium test, furthermore, we applied mechanical scarification and boiler shocks for 5 s, 10 s and 15 s treatments. Morphological characterization of the seed coat was by Scanning Electron Microscope (SEM). Seed viability in E. cyclocarpum and P. piscipula were 100% and 96%, respectively. Seed permeability and imbibition rate in E. cyclocarpum were low. The highest germination in E. cyclocarpum was in the mechanical scarification (92%), while in P. piscipula, this parameter was in the 10 s boiling water treatment (76.0%). The presence of PY was confirmed in both species because they showed low seed permeability, and imbibition rate; furthermore, exhibited macrosclereids cells. The present research seeks to promote the sustainable use of E. cyclocarpum and P. piscipula.

An in vitro human mammary epithelial cell permeability assay to assess drug secretion into breast milk.

Determining the amount of a drug transferred into breast milk is critical for benefit-risk analysis of breastfeeding when a lactating mother takes medications. In this study, we developed a human mammary epithelial cell (MEC)-based permeability assay to assess drug permeability across the mammary epithelium. Human MEC cell MCF10F formed tight junctions when cultured on Transwells with culture medium containing insulin, hydrocortisone and epidermal growth factor (EGF). Formation of integral cell barrier and morphology of the cells were confirmed by assessing trans-epithelial electrical resistance (TEER), flux of fluorescent tracers and imaging with transmission electron microscopy (TEM). MCF10F cells showed consistent P-glycoprotein (P-gp) transporter expression when culturing on Transwell inserts versus on petri dish. A few P-gp transporter drug substrates were used to estimate the permeability from this assay. Human plasma and breast milk were used as incubation medium in basolateral and apical chambers respectively to mimic physiological conditions. The predicted milk to plasma (M/P) ratios were reasonably good. The current effort to develop the MEC-based permeability assay to facilitate M/P ratio prediction showed promising results. This assay may have a potential to be developed as a useful in vitro technique for determining the transfer of small-molecule therapeutic drugs into breast milk.

Telemedicina una alternativa de atención durante la pandemia por Covid-1 / Telemedicine an alternative for medical practice during the Covid-19 pandemic. Review Article

La aparición de la pandemia por Covid-19, su alto contagio e impacto en la salud de poblaciones vulnerables y la necesidad de distanciamiento social, obligó a adaptar rápidamente los procesos de atención ambulatoria a pacientes por medio de herramientas tecnológicas con eventos de atención no presencial (teleconsulta). El propósito de este artículo es revisarla información más relevante sobre el uso de la telemedicina y su impacto actual

The emergence of the Covid-19 pandemic, its high contagion and impact on the health of vulnerable populations and the need for social distancing, forced the rapid adaptation of outpatient care processes by means of technological tools with non-face-to-face care events (teleconsultation). The purpose of this article is to review the most relevant information on the use of telemedicine and its current impact.

Compromiso del Sistema Nervioso Periférico en la infección por Sars-CoV-2 / Peripheral Nervous System involvement in Sars-CoV-2 infection

En diciembre de 2019 en China, inicia una de las pandemias más complejas del último siglo. En efecto, la infección por Sars-CoV-2 o Covid-19, como fue denominada por la Organización Mundial de la Salud, es sin duda una emergencia en salud pública que ha requerido implementar modificaciones de los sistemas de salud en el mundo para su atención. Los síntomas respiratorios son la base de las principales complicaciones de esta infección; sin embargo, se encuentra disponible información relevante sobre las manifestaciones neurológicas asociadas al Sars-CoV-2, en especial con relación al compromiso del sistema nervioso central (SNC); por el contrario, los estudios sobre el impacto del nervio periférico son más escasos. La presente revisión se centra en las manifestaciones neurológicas periféricas asociadas al Covid-19.

In December 2019 in China, one of the most complex pandemics of the last century begins. Indeed, the Sars-CoV-2 or Covid-19 infection, as it was named by the World Health Organization, is undoubtedly a public health emergency that has required the implementation of modifications in the world's health systems for its care. Respiratory symptoms are the basis of the main complications of this infection; however, relevant information is available on the neurological manifestations associated with Sars-CoV-2, especially in relation to central nervous system (CNS) involvement; in contrast, studies on the impact of the peripheral nerve are scarcer. The present review focuses on the peripheral neurological manifestations associated with Covid-19.

Acquisition of obligate mutualist symbionts during the larval stage is not beneficial for a coral host.

Theory suggests that the direct transmission of beneficial endosymbionts (mutualists) from parents to offspring (vertical transmission) in animal hosts is advantageous and evolutionarily stable, yet many host species instead acquire their symbionts from the environment (horizontal acquisition). An outstanding question in marine biology is why some scleractinian corals do not provision their eggs and larvae with the endosymbiotic dinoflagellates that are necessary for a juvenile's ultimate survival. We tested whether the acquisition of photosynthetic endosymbionts (family Symbiodiniaceae) during the planktonic larval stage was advantageous, as is widely assumed, in the ecologically important and threatened Caribbean reef-building coral Orbicella faveolata. Following larval acquisition, similar changes occurred in host energetic lipid use and gene expression regardless of whether their symbionts were photosynthesizing, suggesting the symbionts did not provide the energetic benefit characteristic of the mutualism in adults. Larvae that acquired photosymbionts isolated from conspecific adults on their natal reef exhibited a reduction in swimming, which may interfere with their ability to find suitable settlement substrate, and also a decrease in survival. Larvae exposed to two cultured algal species did not exhibit differences in survival, but decreased their swimming activity in response to one species. We conclude that acquiring photosymbionts during the larval stage confers no advantages and can in fact be disadvantageous to this coral host. The timing of symbiont acquisition appears to be a critical component of a host's life history strategy and overall reproductive fitness, and this timing itself appears to be under selective pressure.

Compromiso de seno cavernoso como presentación de cáncer anaplásico de tiroides / Cavernous sinus involvement as presentation of anaplastic thyroid cancer

Anaplastic thyroid cancer is an uncommon malignant tumor, usually fatal, primarily affecting older adults and doesn't have effective systemic therapy. The median survival is less than 6 months from diagnosis. Brain metastases are low frequency and reach 18 percent. We present the case of a patient with papillary carcinoma of the thyroid who takes an aggressive form, becoming anaplastic carcinoma, with involvement of the central nervous system (CNS) manifested by paralysis of the cranial nerve IV, which is rare clinical condition.

Cáncer diferenciado de tiroides en tiroides lingual, presentación de un caso / Differentiated thyroid cancer in the lingual thyroid, presentation of a case

The lingual thyroid carcinoma is very uncommon neoplasia with an incidence of less than 1 percent. The papillary variant is the most frequent. Cervical MRI helps differentiate muscle from thyroid tissue. The definitive diagnosis is given by histology. Management is similar to that of orthotopic thyroid cancer. We present the case of a 23-year-old woman with hypothyroidism undergoing treatment with dysphagia and sensation of pharyngeal foreign body and malodorous oral bleeding. Nasopharyngoscopy showed a rounded mass at the base of the tongue; the biopsy was compatible with thyroid neoplasia. Image study with ultrasound confirms empty thyroid bed with presence of lingual ectopic thyroid. The team of surgeons performed surgery with Trotter Technique, they removed a tumor of 4 centimeters of diameter. The definitive biopsy concludes minimally invasive follicular carcinoma. The treatment was completed with 100 mCi of radioiodine. Systemic screening at 7 days was negative, as the post-operative thyroglobulin (Tg)

Efectos cardiovasculares de un protocolo de reacondicionamiento físico en pacientes críticos de tres centros asistenciales en Bogotá, Colombia / Cardiovascular effects as a result of a physical conditioning protocol on a critical care in- patient, at three medical centers in Bogotá - Colombia

El síndrome de desacondicionamiento físico es una complicación frecuente en los pacientes con reposo prolongado; su principal característica es la atrofia muscular que afecta principalmente las fibras musculares tipo II y se asocia a un daño de la placa neuromuscular. Esto conlleva a múltiples alteraciones metabólicas y sistémicas, como la dificultad para abandonar la ventilación mecánica, la fatiga, el retorno tardío a las actividades de la vida cotidiana y períodos de rehabilitación prolongados. El presente estudio tuvo como objetivo describir los cambios cardiovasculares en pacientes hospitalizados en unidades de cuidado intensivo, al aplicar un protocolo de actividad física dirigida como parte de la rehabilitación. Se trata de un estudio descriptivo tipo serie de casos que se realizó en tres unidades de cuidado intensivo de tipo polivalente durante un año con una muestra de 23 pacientes que tuvieron una estancia superior a 72 horas y que como parte del manejo recibieron ventilación mecánica. Se evaluaron como parámetros cardiovasculares la presión arterial y la frecuencia cardíaca antes, durante y después de cada una de las cargas aplicadas, las cuales fueron ajustadas por un especialista en medicina de la actividad física y del deporte de acuerdo a la evolución clínica y posteriormente registradas en una escala del uno al treinta y dos. Se analizaron los datos de las variables cardiovasculares por medio de estadísticas no paramétricas sin encontrar diferencias significativas concluyendo que en pacientes críticos, la utilización de cargas orientadas por parte del especialista idóneo, no tiene efecto cardiovascular considerable y puede mantenerse como parte de los protocolos de rehabilitación. MÉD.UIS. 2016;29(2):161-73.

The deconditioning syndrome is a frequent complication among prolonged hospital in-staying patients. It is composed by muscle atrophy which mainly affects type II fibers and it is associated with a neuromuscular junction damage. All this leads to many metabolic and systemic alterations, standing out mechanic ventilation weaning difficulty, fatigue, late return to daily activities and prolonged rehabilitation periods. The purpose was to describe the cardiovascular changes in Intensive Care Unit patients, once a guided physical activity protocol took place as part of the rehabilitation. It is a one year series of cases - descriptive study that took place in three polyvalent type - Intensive Care Units, with a sample of above 72 hours in-stay 23 patients which were having mechanical ventilation support simultaneously. As cardiovascular parameters where checked blood pressure and heart rate at three different times: before, during and after each one of the physical activity loads which were adjusted by a physical and sports medicine physician according to the clinical progress and registered according a 1 to 32 load scale. Cardiovascular data was analyzed with non-parametrical statistics. No significant differences were found; concluding that among in-stay critical care patients, idoneus specialist guided physical activity loads, have no considerable cardiovascular effect and can be kept as a part of a rehabilitation protocol. MÉD.UIS. 2016;29(2):161-73.

Paths of water entry and structures involved in the breaking of seed dormancy of Lupinus.

Physical dormancy is the water impermeability of the seed coat caused by one or more palisade cell layer(s) called macrosclereids. The specialised structure for water entry sites is the water gap, which serves as a detector of environmental cues for germination. In Fabaceae, the water gap is the lens, although another seed structure for water entry could exist. In this study, we identified the initial site of water entry, observed the hydration of a cushion-like structure near the radicle, described the anatomy of the water gap, and analysed the association of anatomical seed traits with the initial site of water entry and the imbibition velocity of six species of Lupinus from the state of Jalisco, Mexico. Dye tracking with a toluidine blue solution was used to identify the initial site of water entry. The anatomical description was performed using conventional microtechnique and a light microscope. The entry of the toluidine solution into seeds of L. montanus was observed after 6h, followed by L. exaltatus and L. mexicanus after 18h and L. elegans, L. reflexus and L. rotundiflorus after 48h. The site of water entry was the lens in L. elegans, L. exaltatus, L. reflexus and L. rotundiflorus and the micropyle in L. mexicanus and L. montanus. The cushion-like structure was responsible for water accumulation in embryo imbibition. Significant differences among anatomical seed traits such as thickness in the hilar region, the counter-palisade layer, cushion-like structure, epidermis, hypodermis, and innermost parenchyma layer were found among the species.

Oxidative status in testis and epididymal sperm parameters after acute and chronic stress by cold-water immersion in the adult rat.

Stress is associated with detrimental effects on male reproductive function. It is known that stress increases reactive oxygen species (ROS) generation in the male reproductive tract. High ROS levels may be linked to low sperm quality and male infertility. However, it is still not clear if ROS are generated by stress in the testis. The objective of this study was to characterize the role of oxidative stress induced by cold-water immersion stress in the testis of adult male rats and its relation with alterations in cauda epididymal sperm. Adult male rats were exposed to acute stress or chronic stress by cold-water immersion. Rats were sacrificed at 0, 6, 12, and 24 hours immediately following acute stress exposure, and after 20, 40, and 50 days of chronic stress. ROS production increased only at 6 hours post-stress, while the activity and expression of antioxidant enzymes, lipid peroxidation (LPO), and sperm parameters were not modified in the testis. Corticosterone increased immediately after acute stress, whereas testosterone was not modified. After chronic stress, testicular absolute weight decreased; in addition, ROS production and LPO increased at 20, 40, and 50 days. The activity of superoxide dismutase (SOD) and glutathione peroxidase (GPx) decreased throughout the duration of chronic stress and the activity of catalase (CAT) decreased at 40 and 50 days, and increased at 20 days. The expression of copper/zinc superoxide dismutase (SOD1) and CAT were not modified, but the expression of phospholipid hydroperoxide glutathione peroxidase (GPx-4) decreased at 20 days. Motility, viability, and sperm count decreased, while abnormal sperm increased with chronic stress. These results suggest that during acute stress there is a redox state regulation in the testis since no deleterious effect was observed. In contrast, equilibrium redox is lost during chronic stress, with low enzyme activity but without modifying their expression. In addition, corticosterone increased while testosterone decreased, this decrease is related to the negative effects seen in sperm.

Endothelial-specific Notch blockade inhibits vascular function and tumor growth through an eNOS-dependent mechanism.

Notch signaling is important for tumor angiogenesis induced by vascular endothelial growth factor A. Blockade of the Notch ligand Dll4 inhibits tumor growth in a paradoxical way. Dll4 inhibition increases endothelial cell sprouting, but vessels show reduced perfusion. The reason for this lack of perfusion is not currently understood. Here we report that inhibition of Notch signaling in endothelial cell using an inducible binary transgenic system limits VEGFA-driven tumor growth and causes endothelial dysfunction. Neither excessive endothelial cell sprouting nor defects of pericyte abundance accompanied the inhibition of tumor growth and functional vasculature. However, biochemical and functional analysis revealed that endothelial nitric oxide production is decreased by Notch inhibition. Treatment with the soluble guanylate cyclase activator BAY41-2272, a vasorelaxing agent that acts downstream of endothelial nitric oxide synthase (eNOS) by directly activating its soluble guanylyl cyclase receptor, rescued blood vessel function and tumor growth. We show that reduction in nitric oxide signaling is an early alteration induced by Notch inhibition and suggest that lack of functional vessels observed with Notch inhibition is secondary to inhibition of nitric oxide signaling. Coculture and tumor growth assays reveal that Notch-mediated nitric oxide production in endothelial cell requires VEGFA signaling. Together, our data support that eNOS inhibition is responsible for the tumor growth and vascular function defects induced by endothelial Notch inhibition. This study uncovers a novel mechanism of nitric oxide production in endothelial cells in tumors, with implications for understanding the peculiar character of tumor blood vessels.

Efectividad de la vacuna antirotavirica / ss

Apoyar en la recolección de datos de los casos y controles del estudio de efectividad de la vacuna de rotavirus en el Hospital Materno Infantil de la ciudad de La Paz

Functional expression and intracellular signaling of UTP-sensitive P2Y receptors in theca-interstitial cells.

BACKGROUND: Purinergic receptors are expressed in the ovary of different species; their physiological roles remain to be elucidated. UTP-sensitive P2Y receptor activity may regulate cell proliferation. The aim of the present work was to study the functional expression of these receptors in theca/interstitial cells (TIC). METHODS: TIC were isolated by centrifugation in a Percoll gradient. P2Y receptors and cellular markers in TIC were detected by RT-PCR and Western blot. Intracellular calcium mobilization induced by purinergic drugs was evaluated by fluorescence microscopy, phosphorylation of MAPK p44/p42 and of cAMP response element binding protein (CREB) was determined by Western blot and proliferation was quantified by [3H]-thymidine incorporation into DNA. RESULTS: RT-PCR showed expression of p2y2r and p2y6r transcripts, expression of the corresponding proteins was confirmed. UTP and UDP, agonists for P2Y2 and P2Y6 receptors, induced an intracellular calcium increase with a maximum of more than 400% and 200% of basal level, respectively. The response elicited by UTP had an EC50 of 3.5 +/- 1.01 microM, while that for UDP was 3.24 +/- 0.82 microM. To explore components of the pathway activated by these receptors, we evaluated the phosphorylation induced by UTP or UDP of MAPK p44 and p42. It was found that UTP increased MAPK phosphorylation by up to 550% with an EC50 of 3.34 +/- 0.92 and 1.41 +/- 0.67 microM, for p44 and p42, respectively; these increases were blocked by suramin. UDP also induced p44/p42 phosphorylation, but at high concentrations. Phosphorylation of p44/p42 was dependent on PKC and intracellular calcium. To explore possible roles of this pathway in cell physiology, cell proliferation and hCG-induced CREB-phosphorylation assays were performed; results showed that agonists increased cell proliferation and prevented CREB-phosphorylation. CONCLUSION: Here, it is shown that UTP-sensitive P2Y receptors are expressed in cultured TIC and that these receptors had the ability to activate mitogenic signaling pathways and to promote cell proliferation, as well as to prevent CREB-phosphorylation by hCG. Regulation of TIC proliferation and steroidogenesis is relevant in ovarian pathophysiology since theca hyperplasia is involved in polycystic ovarian syndrome. Purinergic receptors described might represent an important new set of molecular therapeutic targets.

Use of linear programming to calculate dwell times for the design of petal tools.

Two constraints in the design of a petal tool are, the angles that define it must all be positive, and wear must never be greater than the desired wear. The first constraint is equivalent to that of the positive dwell times of a small solid tool. In view of this foregoing, we present a design of petal tools that are used to generate conic surfaces from their nearest spheres and that correct the profile of a surface that is polished. We study optimal angular sizes of a petal tool, which are found after we use linear programming to calculate the optimal dwell times of a set of complete annular tools placed in different zones of the glass surface. We report numerical results of designed petal tools.

Tratamiento laparoscópico de la colecistitis aguda: variables que inciden en el alta / Laparoscopic treatment of the acute cholecystitis

La asociación entre los factores preoperatorios, intraoperatorios postoperatorios y la duración de la estadía postoperatoria (DEP) en la colecistectomía laparoscópico (CL) por colecistitis aguda (CA), no ha sido bien estudiada. El objetivo de este estudio retrospectivo fue determinar qué factores afectan significativamente la DEP en pacientes sometidos a CL por colecistitis aguda. Se incluyen en el estudio las fichas clínicas de 193 pacientes sometidos a CL por CA, en un período comprometido entre abril de 1993 a abril de 2000 en nuestra institución. Los factores que afectan significativamente la DEP son: limitación crónica del flujo aéreo, presencia de empiema, grangrena y plastrón vesicular, pedículo de disección difícil, vesícula empotrada y la conversión, así como también en el postoperatorio las infecciones respiratorias altas, neumonía y bilirragia por drenaje; el uso de bolsa para la extración de la vesícula, se asoció a una menor estadía hospitalaria. Un enfoque quirúrgico precoz vía laparoscópica, determina menos estadía postoperatoria; debe recalcarse el uso de la bolsa para la extracción de la vesícula y las medidas tendientes a optimizar la función respiratoria, en el perioperatorio de estos pacientes