Challenges in the surgical treatment and management of the patient with super super obesity.

Obesity is defined by the Body Mass Index (BMI) which is derived by the weight and height of a person (BMI > 30). Furthermore, obesity is classified as super-obesity (BMI >50 kg/m2) and super-super obesity (BMI >60 kg/m2) by the International Bariatric Surgery Registry (Renquist K. Obesity classification. Obes Surg 1997;7:523). Patients with super-super obesity have a greater incidence of comorbid diseases and are at greater risk of postoperative morbidity and mortality and longer length of hospital stay (LOS). Soong et al. described short-term outcomes after weight loss surgery comparing a group of patients with super-obesity with another group of patients with super-super obesity. The authors concluded that experienced surgeons could achieve comparable outcomes in both groups. However, higher BMI is associated with longer operative time, longer LOS, and delayed discharge to chronic care facilities (Soong TC, Lee MH, Lee WJ, et al. Long-term efficacy of bariatric surgery for the treatment of super-obesity: comparison of SG, RYGB, and OAGB. Obes Surg. 2021;31:3391-99. https://doi.org/10.1007/s11695-021-05464-0). The following paradigmatic case report aims at showing the complex management of a patient with super-super obesity, with BMI of 141.2 kg/m2 and associated multiple comorbidities.

Rescate endoscópico de endoprótesis biliar plástica fistulizante / Endoscopic rescue of a fistulizing biliary plastic stent

55-year-old male with a history of cholecystectomy complicated by perforation of the common bile duct, contained with placement of a plastic biliary stent. He presented several subsequent episodes of recurrent cholangitis secondary to biliary lithiasis and residual benign stenosis of the common bile duct, resolved with the implantation of plastic biliary prostheses. Finally, given the recurrent episodes of cholangitis, it was agreed to perform a hepaticojejunostomy. During the operation, the last implanted stent was not detected, which was identified by CT scan of the abdomen, causing a fistulous tract between the duodenum and the ascending colon. The stent was removed endoscopically, without complications, and the fistulous tract was resolved.(AU)

Endoscopic rescue of a fistulizing biliary plastic stent.

55-year-old male with a history of cholecystectomy complicated by perforation of the common bile duct, contained with placement of a plastic biliary stent. He presented several subsequent episodes of recurrent cholangitis secondary to biliary lithiasis and residual benign stenosis of the common bile duct, resolved with the implantation of plastic biliary prostheses. Finally, given the recurrent episodes of cholangitis, it was agreed to perform a hepaticojejunostomy. During the operation, the last implanted stent was not detected, which was identified by CT scan of the abdomen, causing a fistulous tract between the duodenum and the ascending colon. The stent was removed endoscopically, without complications, and the fistulous tract was resolved.

Síndrome del conducto pancreático desconectado. Abordaje endoscópico. / Disconnected pancreatic duct syndrome. Endoscopic approach

El síndrome del conducto pancreático desconectado (SCPD) es debido a la interrupción del conducto pancreático (CP) principal o sus ramas secundarias, complicación presente entre un 30-80% de las pancreatitis agudas necrotizantes. La secreción de enzimas pancreáticas por el tejido pancreático aislado funcionante puede facilitar la recurrencia de colecciones necróticas encapsuladas, por lo que su manejo endoscópico sigue siendo un tema controvertido en la práctica diaria. Exponemos un caso de síndrome de ducto pancreático desconectado resuelto tras colocación de prótesis pancreática. (AU)

Caracterización de los determinantes sociales de la salud del envejecimiento activo en estudios enfocados a la calidad de vida: mapeo sistemático / Characterization of the social determinants of health in active aging in studies focused on quality of life: systematic mapping

Resumen El aumento demográfico de adultos mayores se está presentando acompañado de condiciones socioeconómicas y de salud desfavorables, que afectan su calidad de vida. Esta situación puede paliarse a través del marco del envejecimiento activo, el cual aporta lineamientos alternativos que pueden resultar eficaces para contrarrestarlos. La Organización Mundial de la Salud establece que el envejecimiento activo tiene seis Determinantes Sociales de la Salud (DSS) que han sido abordados desde diferentes áreas por la comunidad científica. El objetivo del presente trabajo fue identificar y caracterizar el tipo de estudios enfocados a la calidad de vida, desde el envejecimiento activo, y clasificarlos de acuerdo con los DSS. Se revisaron las bases de datos Ebscohost, Scopus, Oxford, Redalyc y Sage Journals. Los descriptores utilizados fueron "envejecimiento activo" y "calidad de vida", en inglés y español. La búsqueda del mapeo sistemático comprendió enero 2015 a marzo 2022. Se localizaron 91 artículos en los que se evaluó la calidad de vida, desde la perspectiva del envejecimiento activo y la mayoría (81.3 %) fueron estudios transversales. Se identificaron 3 intervenciones psicológicas, con evaluación antes y después de las sesiones, abordando los DSS relacionados con los factores personales, como salud psicológica, percepción positiva con la actividad física y función cognitiva. Así mismo, los factores conductuales, como estilos de vida para la prevención de riesgo de caídas y mejora de la vida en general, que podrían condicionar la calidad de vida. El principal alcance temático de los estudios fue la vinculación existente entre la calidad de vida y los DSS relacionados con los factores personales y con el entorno social. Se requieren más estudios interdisciplinarios que ayuden a generar políticas públicas que impacten favorablemente en este sector poblacional.

Abstract The demographic increase of elderly people is taking place along with unfavorable socioeconomic and health conditions, which affect their quality of life. This situation can be alleviated through an active aging framework, which provides alternative guidelines that can be effective in counteracting them. The World Health Organization establishes that active aging has six Social Determinants of Health (SDH) that have been approached from different areas by the scientific community. The objective of this work was to identify and characterize the type of studies focused on quality of life, from active aging, and classify them according to the SDH. Ebscohost, Scopus, Oxford, Redalyc and Sage Journals databases were reviewed. The descriptors used were "active aging" and "quality of life", in English and Spanish. The systematic mapping search comprised from January 2015 to March 2022. 91 articles were located where quality of life was evaluated from the perspective of active aging and the majority (81.3 %) were cross-sectional studies. Three psychological interventions were identified, with an evaluation before and after the sessions, comprising the SDH related to personal factors, such as psychological health, positive perception with physical activity and cognitive function. Likewise, behavioral factors such as lifestyles for the prevention of risk of falls and general life improvement which could condition the quality of life. The main thematic scope of the analyzed studies was the existing relationship between quality of life and the SDH related to personal factors and the social environment. Further interdisciplinary studies are required to contribute to the creation of public policy that impacts favorably this sector of the population.

Disconnected pancreatic duct syndrome. Endoscopic approach.

Disconnected pancreatic duct syndrome (DPCS) is due to disruption of the main pancreatic duct (PC) or its secondary branches, a complication present in 30-80% of acute necrotizing pancreatitis. The secretion of pancreatic enzymes by isolated functioning pancreatic tissue can facilitate the recurrence of encapsulated necrotic collections, so its endoscopic management remains a controversial issue in daily practice. We present a case of disconnected pancreatic duct syndrome resolved after placement of a pancreatic stent.

Insurance Type and Surgical-Patient Characteristics in the UPR-Affiliated Hospitals.

OBJECTIVE: The characteristics of surgical patients were examined according to type of health insurance to determine whether differences existed between these groups. METHODS: We evaluated the characteristics of cases in the UPR General Surgery Department's database (entered from January 1, 2018 through December 31, 2018) by insurance type. The variables examined included age, gender, inpatient/outpatient status, wound classification, type of surgery, American Society of Anesthesiology (ASA) scores and whether a given patient had diabetes, was a smoker, or suffered from hypertension. This database had no trauma cases. RESULTS: Information was available for 5,097 cases during the study period. The mean age of the group was 51 (±22) years. The gender distribution indicated that 56% were women and 44% were men. The insurance types were distributed as follows: government/no insurance, 40%; Medicare, 12%; and private insurance, 48%. The government-insured/uninsured patients were younger (mean age, 41 ±24) and had had emergency surgery more frequently (18%) than had privately insured patients (10%). Medicare patients were significantly older (mean age, 72 ±12), and had had higher incidences of diabetes (46%) and hypertension (81%), presenting with ASA scores greater than or equal to 3 in 73% of cases. More privately insured individuals than those in other groups had had elective surgery (90%); 48% had been outpatients when they had their surgery, 58% had had clean wounds, and 61% of the patients having elective surgery were women. CONCLUSION: There were significant differences (P<.05) in the characteristics of patients with different types of health insurance. The frequency of emergency surgery was found to be significantly higher in the government-insured/uninsured group than in the privately insured group.

Megacolon de etiología infecciosa poco frecuente en nuestro país: enfermedad de Chagas / No disponible

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Megacolon with infectious etiology that is infrequent in our country: Chagas disease.

We present the case of a 37-year-old male with constipation refractory to medical treatment, in the context of megacolon due to Chagas disease. The entire gastrointestinal tract may be affected but the digestive form is characterized by megaesophagus and megacolon. There is altered peristalsis due to the destruction of the neurons of the enteric nervous system caused by the parasite. Although the mortality rate is low, the disease can have a considerable impact upon quality of life. Chagas disease is poorly recognized and undertreated by healthcare providers in non-endemic regions.

Validation of a Spanish-Language Questionnaire on Adolescent Eating Behavior Based on Social Cognitive Theory.

OBJECTIVE: To validate a Spanish-language questionnaire on adolescent eating behavior based on Social Cognitive Theory. DESIGN: The validity (reliability and construct validity) of a self-administered questionnaire containing 28 questions with Likert scale-type response options was evaluated. SETTING: School located in Tonala, Jalisco, Mexico (a peri-urban area) with approximately 1,400 students enrolled. PARTICIPANTS: One hundred fifty-two adolescents enrolled in the second year of a middle school in Tonalá, Jalisco, Mexico (mean age, 13.7 years; SD, 0.5 years; 64% female). The retest was completed by 70 adolescents chosen at random. OUTCOME MEASURES AND ANALYSIS: The questionnaire's reliability was measured through internal consistency (Cronbach α) and reproducibility (intraclass correlation coefficient [ICC]). Construct validity was assessed using exploratory factor analysis. RESULTS: Five questions were eliminated from the questionnaire because of a lack of temporal stability (ICC ≤0.4). The exploratory factor analysis was satisfactory for 3 factors (41.89% of variance): environmental facilitators and social support, self-efficacy and self-regulation, and outcome expectations and outcome expectations value. The questionnaire had good internal consistency (α = 0.824) and excellent temporal stability (ICC = 0.849). CONCLUSIONS AND IMPLICATIONS: The results substantiate the reliability and construct validity of this questionnaire. The questionnaire has the potential to use the assessment of Social Cognitive Theory constructs in clinical practice or in nutrition interventions aimed at modifying the eating habits of Spanish-speaking adolescents.

Colecistitis xantogranulomatosa: diagnóstico diferencial con colecistitis aguda y cáncer de vesícula / No disponible

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Xanthogranulomatous cholecystitis: differential diagnosis between acute cholecystitis and gallbladder cancer.

We present the images of ultrasound, magnetic resonance and histology of a patient with suggestive findings of xanthogranulomatous cholecystitis. Gallbladder cancer cannot be completely ruled out until the histological study of the surgical sample is performed.

Perforación de colon por fistulización de pseudoquiste pancreático / Colon perforation due to fistulization of a pancreatic pseudocyst

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Prevalence of Pica in Patients on Dialysis and its Association With Nutritional Status.

OBJECTIVE: Pica could be strongly implicated in nutritional status of patients on dialysis; however, very scarce data are currently available. The objective of this study was to evaluate the prevalence of pica and its association with nutritional status in dialysis patients. DESIGN AND METHODS: This is a cross-sectional study in a tertiary care teaching hospital. Four-hundred patients on dialysis, without previous pica diagnosis or transplant, pregnancy, mental illness, or infection, were included in the study. Pica, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was classified as no pica, ice pica, or hard pica. Dialysis Malnutrition Score, 24-hour dietary recall, and biochemical measurements were obtained from patients. As part of statistical analysis, point prevalence and 95% confidence interval of pica were calculated. Comparisons between groups were performed by means of analysis of variance, Kruskal-Wallis test, χ2, or Fisher exact tests, as appropriate. A multivariate analysis was performed by multinomial logistic regression. RESULTS: Prevalence of pica was 42% (ice pica, 46%; soil, 29%; two substances, 14%; red brick, 5%; paper, 3%; soap, 2%; and cattle pasture, 1%). Comparing patients with pica (hard pica and ice pica) versus no pica, subjects with pica were of younger age (25 ± 7, 27 ± 9, 30 ± 11 years, respectively), were more frequently educated <9 years (57%, 46%, 30%, respectively), and had longer dialysis duration (36 ± 19, 32 ± 18, 27 ± 16 months, respectively). Patients with pica achieved the recommended calorie and macronutrients intake target less frequently than those without pica (40-64% vs. 66-77%, P <.05). Malnutrition was present in 74% of the whole sample: (1) 67% in no pica group, (2) 80% in ice pica group, and (3) 89% in hard pica group (P = .001). In the multivariate analysis (R2, 0.27; P < .0001), malnutrition, C-reactive protein, and lower educational level significantly predicted both ice and hard pica. CONCLUSIONS: A worse nutritional status was observed in patients with pica, who additionally were younger, had lower educational level, longer dialysis duration, and worse macronutrient intake routine than patients without pica. Malnutrition, C-reactive protein, and lower educational level significantly predicted both ice and hard pica.

Colon perforation due to fistulization of a pancreatic pseudocyst.

We present a computed tomography image of a patient with acute necrotizing pancreatitis due to alcohol, who developed several pseudocysts, one of which fistulized into the colon.

Competencia y compartimiento emocional en usuarios de cocaína: Psicometría y relación con variables sociodemográficas y clínicas / Emotional competence and magazine in cocaine users: Psychometrics and relationship with sociodemographic and clinical variables

INTRODUCCIÓN: Existe evidencia de relación entre factores emocionales y el consumo de drogas. Sin embargo, al menos la competencia emocional y el compartimiento social de las emociones en usuarios de cocaína no han sido estudiados con anterioridad, en parte debido a la reciente generación de las herramientas para su medición. OBJETIVO: Evaluar las características psicométricas de la Escala de Alexitimia de Toronto (EAT), el Cuestionario de Competencias Emocionales (CEMO), y el Cuestionario de Creencias sobre los efectos de Compartimiento Social de Emociones (CCSE) en pacientes mexicanos usuarios de cocaína, así como establecer su relación con variables socio-demográficas y clínicas. MÉTODO: Los instrumentos fueron completados junto con las Escalas de Afectividad Positiva (AP) y Negativa (AN) en dos ocasiones por 158 pacientes usuarios de cocaína. RESULTADOS: Las tres escalas mostraron coeficientes alpha superiores a .70. La EAT y el CEMO presentaron alta estabilidad temporal a quince días. La AN se asoció positivamente con la EAT y negativamente con el CEMO. La AP se correlacionó negativamente con la EAT y positivamente con el CEMO y el CCSE. El 50.9% de los pacientes presentaron una dificultad relevante en la identificación y la expresión de sus emociones, que se relacionó de forma negativa con la escolaridad. DISCUSIÓN Y CONCLUSIÓN: Se sugiere necesaria la sistematización de la evaluación y el tratamiento de las dificultades en la expresión emocional de usuarios de cocaína. Las versiones en español de las escalas evaluadas en este estudio resultaron válidas y confiables para su uso clínico y de investigación en pacientes mexicanos usuarios de cocaína.

INTRODUCTION: Current evidence suggests a relationship between emotional factors and drugs consumption, although at least both emotional competence and social magazine of emotions have not been studied in cocaine users, in part due to the recent generation of tools for their measure. OBJECTIVE: To evaluate the psychometric properties of the Toronto Alexithymia Scale (TAS), Emotional Competence Questionnaire (ECQ), and the Questionnaire about Beliefs in the effects of the Social Magazine of Emotions (QSME) in Mexican cocaine users, and to establish its relationship with socio-demographic and clinical variables. METHOD: All instruments, as well as the Positive Affectivity (PA) and Negative Affectivity (NA) Scales, were completed twice by 158 cocaine users. RESULTS: All scales showed alpha coefficients greater than .70. The TAS and ECQ presented high temporal stability. NA was positively associated with TAS, and negatively with ESQ. PA showed a negative correlation with TAS, and a positive relation with ECQ and QSME. 50.9% of the patients had a relevant difficulty in identifying and expressing their emotions, which was negatively correlated with schooling. DISCUSSION AND CONCLUSION: A systematic evaluation and treatment of difficulties in the expression of emotions in cocaine users seems to be necessary. The Spanish versions of the scales are valid and reliable for their use with clinical and research purposes in Mexican cocaine users.

Motivación e incentivo como factores determinantes en la elección de la especialidad médica / Motivation and incentive as determinant factors in the selection of medical specialities

Entre los educadores médicos existe la inquietud de conocer cuáles son los factores que intervienen en la elección de la especialidad de los médicos que ingresan a una residencia. Investigaciones efectuadas previamente han encontrado que ciertos elementos de personalidad favorecen la selección, como la ansiedad ante la muerte y el autoritarismo, la confianza en sí mismo, la necesidad de dominio y los interes vocacionales; además, las opiniones que se forman acerca del atractivo social de las diferentes especialidades. También se ha informado que cuestiones sociales, económicas, religiosas y estéticas influyen en los médicos al escoger la especialidad, o bien el sexo a que se pertenece, al igual que la habilidad de expresión verbal, la actitud frente a la ciencia y la información general que se posee. En este artículo se exploran algunos factores motivacionales y ambientales de incentivación que pudieran haber influido en la elección de especialidad en una muestra de médicos residentes rotatorios del IMSS a quienes se les aplicó una batería de pruebas psicométricas y se les informó de las posibilidades de contratación, según la especialidad, al término de sus estudios. Se encontró que la gran mayoría eligió su especialidad al inicio del curso de introducción a la especialización médica y que las pruebas psicométricas demostraron un perfil de aptitudes e intereses y rasgos predominantes de personalidad que caracterizan a los grupos de cirugía general, ginecobstetricia, medicina interna y pediatría médica