Sleep Disturbances among Caregivers of Home-Isolated and Hospitalized COVID-19 Patients: A Multi-National Cross-Sectional Study.

Background: Since the coronavirus (COVID-19) pandemic began, several studies were published on the possible prevention and treatment of the disease caused by severe acute respiratory syndrome coronavirus (SARSCoV-2), and its complications. However, one aspect that was overlooked is the impact on the mental health of the caregivers of COVID-19 patients. The current study endeavors to investigate sleep quality disturbances in the caregivers of COVID-19 patients in different countries. Material and Methods: This cross-sectional multi-center study was performed between August 1, 2021, and August 30, 2022, across 11 countries. A total of 2411 responses meeting the inclusion criteria (being a family member or caregiver involved in patient care) were collected. The sleep quality was assessed using the self-reported Pittsburgh Sleep Quality Index (PSQI) 12. Total scores ranged from 0 to 21. A ≥5 indicated poor sleep quality with 89.6% sensitivity and 86.5% specificity. Results: A total of 2411 responses meeting the inclusion criteria showed that mean PSQI scores (P = 0.3604) were higher in caregivers of hospitalized patients than in patients isolated at home. Approximately 62.4% of caregivers reported sleep quality problems while caring for their patients. Conclusion: The results showed that the majority of caregivers of patients with COVID-19 reported disturbances in sleep quality and impaired sleep was more common among caregivers of hospitalized patients, perhaps because hospitalization is associated with a more severe course of the disease. There is a pressing need to take measures to improve the mental health of these caregivers. There should be treatment programs set up to reverse sleep disturbances in this population sufficiently.

Cierre de conducto arterioso con paracetamol: estudio piloto / Ductus arteriosus closure with paracetamol: a pilot study

No disponible

Derivación ventrículo-cava para hidrocefalia en casos extremos. Una alternativa viable / Ventriculocaval shunt for hydrocephalus in extreme cases. A viable alternative

Introducción. El manejo de la hidrocefalia habitualmente comprende la derivación del líquido cefalorraquídeo hacia alguna cavidad corporal. En circunstancias especiales, los pacientes requieren de abordajes alternos y el cirujano se enfrenta al empleo de opciones extremas. Caso clínico. En este estudio se presentan dos pacientes que se sometieron quirúrgicamente a una derivación ventrículo-cava a través de un acceso vascular periférico. Conclusiones. La técnica representó un abordaje de fácil aplicación y con mínimas complicaciones que nos brinda una opción de rescate en aquellos pacientes complicados. En los casos presentados, el empleo de esta técnica fue exitoso.

Background. Hydrocephalus management usually involves cerebrospinal fluid shunting into some corporal cavity. Under special circumstances, patients require alternate approaches, and the surgeon faces the use of extreme options. Case report. In this study we present two patients who were surgically approached with ventriculocaval shunt through peripheral vascular access. Conclusions. The technique represented an easy application with minimal complications, an approach that provides a rescue option in cases of complicated hydrocephalus. In our case, this technique was successful.

Experiencia en el cierre quirúrgico de ducto arterioso permeable en la Unidad de Cuidados Intensivos Neonatales (UCIN) de un hospital de segundo nivel en Guadalajara, Jalisco, México / Experience in the surgical closure of patent ductus arteriosus in the Neonatal Intensive Care Unit of a second-level hospital in Guadalajara, Jalisco, Mexico

Introducción. El ducto arterioso permeable (DAP) es la cardiopatía congénita más frecuente; afecta hasta el 80% de los recién nacidos pretérmino de extremado bajo peso al nacer (<1 000 g). Actualmente se considera un importante problema de salud pública. El objetivo de este trabajo es demostrar que es posible realizar cierre quirúrgico de DAP en pacientes prematuros, en un hospital de 2° nivel que cuente con un cirujano pediatra entrenado. Métodos. Se analizaron los antecedentes, evolución clínica y manejo quirúrgico de 31 pacientes con diagnóstico de DAP. Los criterios para cierre quirúrgico fueron: 1) fracaso al cierre farmacológico, 2) hipertensión pulmonar moderada a severa con flujo de izquierda a derecha, 3) ecocardiograma con conducto mayor de 1.5 mm y relación Qs/Qp mayor de 1.5:1, 4) más de 5 días de vida extrauterina con DAP-HS. El abordaje fue por toracotomía posterolateral izquierda con disección extrapleural y cierre del DAP con doble ligadura de seda 2-0. Resultados. Se estudiaron 31 pacientes, 19 masculinos y 12 femeninos. La edad varió entre 30 y 35 semanas de gestación; el peso osciló entre 1 y 1.5 kg. El ecocardiograma confirmó el diagnóstico en el 100% de los pacientes. Todos se operaron entre 7 y 10 días de vida extrauterina, 15 de ellos no recibieron tratamiento farmacológico por haber sido diagnosticados tardíamente, 12 por falla al tratamiento farmacológico y 4 hubo alguna contraindicación médica para cierre farmacológico (sepsis, Insuficiencia renal aguda y/o alteraciones de la coagulación). No hubo muertes a consecuencia de la cirugía; los pacientes que fallecieron (5) fue entre 15-20 días posteriores a la cirugía, por otros problemas agregados. Todos los pacientes que sobrevivieron (26 pacientes) pudieron extubarse en un periodo de 2-5 días después de la cirugía. Conclusiones. El cierre quirúrgico de DAP es factible de llevar a cabo en un hospital de 2° nivel, cuando las indicaciones para cierre farmacológico no son posibles. Es un procedimiento sencillo, con complicaciones mínimas, que puede realizarse en la misma Unidad de Cuidados Intensivos Neonatales (UCIN), como demuestran nuestros resultados, con nula mortalidad transoperatoria.

Background: Patent ductus arteriosus (PDA) is the most common congenital cardiac defect affecting 80% of very low birth weight preterm newborns (<1 000 g) and is considered an important public health issue. The aim was to demonstrate that it is possible to perform surgical closure of PDA on premature newborns in a second-level hospital. Methods: We analyzed backgrounds and clinical evolution of 31 surgically treated patients with PDA. Criteria for surgical closure were 1) pharmacological closure failure, 2) pulmonary hypertension with left to right shunt, 3) echocardiogram with ductal diameter >1.5 mm, and Qs/Qp ratio (>1.5:1. 4) at >5 days of extrauterine life. All patients were operated using left posterolateral thoracotomy with extrapleural dissection and ductus closure with a 2-0 double silk ligature. Results: We studied 31 patients: 19 males and 12 females. Age range was between 30 and 35 weeks of gestational age. Birth weight was between 1 and 1.5 kg. Echocardiogram was confirmatory in 100% of patients; 15 patients did not have pharmacological closure, 12 had pharmacological closure failure, and 4 had medical contraindication for pharmacological closure (sepsis, renal failure and coagulation disturbances). There was no surgical mortality. In patients who died (five patients), it was after 15 or 20 postoperative days and due to problems unrelated to the surgical procedure. Conclusions: Surgical closure of PDA is feasible to perform in a second-level hospital with minimal complications. This was demonstrated with our results in those patients in whom pharmacological closure failed or was not indicated.

Efficacy of selective percutaneous embolization for the treatment of intractable posterior epistaxis and juvenile nasopharyngeal angiofibroma (JNA).

CONCLUSION: Percutaneous embolization reduces the reappearance of epistaxis and the mean length of hospital stay for patients with intractable epistaxis or juvenile nasopharyngeal angiofibroma (JNA). OBJECTIVES: To assess whether percutaneous embolization is effective for the treatment of intractable epistaxis and JNA. PATIENTS AND METHODS: Twenty-eight patients with intractable posterior epistaxis treated by embolization (25 males; m = 59.78 years; SD = 14.3) and 28 unembolized patients (24 males; m = 59.21 years; SD = 15.13) were studied retrospectively. Eight patients with JNA (all males; mean = 16.5 years; SD = 2.35; four embolized before surgery and four unembolized) were also analyzed. RESULTS: Embolization was bilateral in 71.4% of subjects, blood transfusion was required in 28.57%, incidence of complications was 53.57%, and seven of the embolized patients with intractable epistaxis suffered from recurrence of the epistaxis. There were no statistically significant differences between the embolized and unembolized groups. The mean hospital stay was longer in unembolized patients (4.46 days; SD = 2.42) than for the embolized patients (3.78 days; SD = 3.9), p=0.394. The most serious complications occurred in patients embolized with idiopathic epistaxis and the mean post-embolization hospital stay was longer in this subgroup (4.14 days; SD = 4.39) than in patients with Rendu-Osler-Weber syndrome (2.40 days; SD = 1.140), p=0.395. Unembolized patients with JNA presented greater hemorrhage (m = 2025 ml; SD = 325) and a longer mean hospital stay (m = 18 days; SD = 3) than the group of embolized patients (m = 360 ml; SD = 185 and m = 9 days; SD = 1, respectively).

Recurrent coital headache associated with an unruptured carotid saccular aneurysm.

We report the case of a 48-year-old woman whose recurrent coital headache ceased following intracranial internal carotid artery aneurysm embolization.

Propuesta de un nuevo puntaje para optimizar estimados ecográficos de peso fetal: estudio piloto / New score to optimize ultrasound fetal weight estimation: a pilot study

Introducción: La estimación del peso fetal es importante para las decisionesobstétricas; la precisión de los estimados ecográficos no ha sido estudiada. Objetivos: Determinar la precisión del estimado ecográfico del peso fetal mediante un puntaje basado en parámetros clínicos, ecográficos y maternos. Diseño: Estudio de tipo transversal. Lugar: Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú. Participantes: 130 gestantes y sus fetos. Intervenciones: Se consignó datos clínicos, ecográficos y maternos. Se procedió a dicotomizar los aciertosentre menor o igual a mas o menos10 por ciento (acertadas) y mayor a mas o menos 10 por ciento (erradas) del peso real. Se analizó las variables clínicas, ecográficas y maternas mediante el uso de las curvas ROC, para identificar aquellas que tuvieron más influencia en la precisión ecográfica. Con las variables identificadas, se procedió al desarrollo de un modelo de regresión logística, para establecer un puntaje que estimara la probabilidad devariación, teniendo como punto de corte mas o menos 10 por ciento del peso real. Principales medidas de resultados: Precisión de un puntaje que relaciona la edad gestacional con la circunferencia abdominal y el diámetro biparietal del feto, el ponderado clínico y el peso materno. Resultados: El nuevo puntaje tuvo un buena capacidad de discriminación de las ecografías, según su variación a mas o menos 10 por ciento del peso real (área bajo la curva ROC: 0,76 p menor que 0,001). Según los puntajes obtenidos, se obtuvo tres grupos: rendimiento alto 20 por ciento, rendimiento convencional 44,4 por ciento y rendimiento bajo 71,2 por ciento. Conclusiones: El nuevo puntaje propuesto tiene la capacidad de estimar la probabilidad de variación de los estimados ecográficos mayores al mas o menos 10 por ciento del pesoreal, conformando tres grupos de rendimiento: alto, convencional y bajo.

Introduction: Fetal weight estimation is important for obstetrical decisions;accuracy of ultrasound fetal weight estimations has not been studied. Objective: To determine ultrasound fetal weight estimations precision by developing a score based on clinical, ultrasound and maternal parameters. Design: Cross sectional study. Setting: Guillermo Almenara Irigoyen National Hospital, Lima, Peru. Participants: 130 pregnant women and their fetuses. Interventions: Clinical, ultrasound and maternal data were collected. We dichotomized predictions as actual birth weight less or equal to mor or less 10 per cent (correct) and more than more or less 10 per cent(erroneous). We analyzed clinical, ultrasonographic and maternal variables using ROC curves in order to identify those with more influence in ultrasound accuracy. With such identified variables we developed a logistic regression model to establish a score that would estimate the probability of variation, having a per cent 10 per cent of real fetal birth weight cut point. Main outcome measures: Precision ofa score that relates gestational age and both fetal abdominal circumference andbiparietal diameter, clinical fetal weight estimation and maternal weight. Results: The resulting score had a good capacity of discrimination of ultrasonographic fetal weight estimations according to their variation to more or less 10 per cent of real birth weight (area under the curve ROC: 0,76 p minor that 0,001). Three groups resulted: high performance 20 per cent, conventional performance 44,4 per cent, and low performance 71,2 per cent. Conclusions: The new score proposed estimates the probability of variation of fetal weight above mroe or less 10 per cent of real birth weight, with three groups of performance: high, conventional and low.

Efectos adversos en la cirugía de la apendicitis aguda / Adverse outcomes in the surgical treatment of acute appendicitis

Objetivo. Describir los efectos adversos en la apendicectomía por apendicitis aguda y analizar las asociaciones entre estos resultados y determinadas características del paciente y del ingreso hospitalario. Material y métodos. Cohorte de 792 pacientes intervenidos de apendicitis aguda en la que se registraron prospectivamente las complicaciones postoperatorias, las reintervenciones y los fallecimientos, y se identificaron retrospectivamente los reingresos. Se utilizó una regresión logística para valorar las asociaciones entre complicaciones y características de los pacientes y del ingreso. Resultados. El 9,8% de los pacientes desarrolló alguna complicación posquirúrgica (infección de herida, 4,2%; complicaciones intraabdominales, 2,1%). El 0,7% requirió reintervención durante el ingreso, el 0,5% precisó ingreso en la UCI y 5 pacientes (0,6%) fallecieron. El 3,2% reingresó en el servicio de cirugía en el año siguiente de la intervención, por un problema relacionado con la cirugía previa. Los casos complicados tuvieron una estancia mayor que los no complicados (9,6 frente a 3,5 días). Las complicaciones posquirúrgicas se asociaron a una mayor edad (45-65 años: odds ratio = 3,62; p 65 años: odds ratio = 8,68; p < 0,001) y a la apendicitis complicada con perforación/peritonitis (odds ratio = 3,69; p < 0,005). El reingreso relacionado con la intervención previa sólo se asoció a la presencia de complicaciones durante el ingreso (odds ratio = 18,79; p < 0,001). Conclusiones. En la apendicectomía, los efectos adversos más relevantes son la infección de la herida y el absceso intraperitoneal, que se relacionan con la mayor edad de los pacientes y con la apendicitis perforada. Este subgrupo de alto riesgo debe alertar al cirujano a extremar la vigilancia en el proceso de atención hospitalaria (AU)

Objectives. To describe adverse outcomes after appendectomy for acute appendicitis and to analyze the association between these outcomes and specific characteristics of the patient and hospital admission. Material and methods. We studied a cohort of 792 patients who underwent appendectomy for acute appendicitis. Postoperative complications, reoperations and deaths were prospectively studied and all readmissions were retrospectively identified. Logistic regression was used to evaluate the relationship between complications and patient characteristics, as well as hospital admission. Results. Postsurgical complications developed in 9.8% of the patients. These complications mainly consisted of surgical wound infection (4.2%) and intra-abdominal complications (2.1%). A total of 0.7% of patients underwent reoperation during admission, 0.5% were admitted to the intensive care unit and five patients (0.6%) died in hospital. The rate of operation-related readmissions in the following year was 3.2%. Length of hospital stay was longer in patients with complications than in those without complications (9.6 and 3.5 days, respectively). Postoperative complications were associated with older age (45-65 years, OR 3.62, p < 0.001; more than 65 years OR 8.68, p < 0.001) and acute appendicitis complicated with peritonitis or perforation (OR 3.69, p < 0.005). Readmissions related to previous surgery were associated only with complications during the first admission (OR 18.79, p < 0.001). Conclusions. In appendectomy, the most frequent adverse outcomes are surgical wound infection and intra-abdominal complications, which are associated with older patients and perforations. This subgroup of patients at high risk requires closer surveillance (AU)

Experiencia en el estudio de efectos adversos en un servicio de cirugía general / Experience with adverse outcomes in a General Surgery Department

Objetivo: Describir los efectos adversos tras la cirugía de la pared abdominal, y analizar las asociaciones entre estos resultados y determinadas características del paciente y del ingreso hospitalario. Material y métodos: Cohorte de 931 pacientes intervenidos de cirugía de la pared abdominal, en la que se registraron, de forma prospectiva, las complicaciones postoperatorias, las reintervenciones y la mortalidad. Se utilizó la regresión logística para valorar las asociaciones entre las complicaciones y las características de los pacientes y del ingreso. Resultados: El 16,3% de los pacientes desarrolló alguna complicación posquirúrgica, entre las que destacan las relacionadas con la herida quirúrgica, que se presentaron en un 9,3% (seroma, 4%; hematoma, 3,7%, e infección, 1,5%). Los fallos orgánicos afectaron al 1,1% de los pacientes y las complicaciones intraabdominales, a menos del 0,5%. El 0,6% de los pacientes requirió reintervención durante el ingreso, el 0,3% precisó ingreso en la UCI y 4 (0,4%) fallecieron durante el ingreso. La presencia de complicaciones se asoció a los grupos de edad superior a 46 años (46-65 años, odds ratio [OR] = 2,06; 66-79 años, OR = 3,11); a los varones (OR = 2,06); al ingreso urgente (OR = 1,85), y a la anestesia locorregional (OR = 1,81) y general (OR = 1,99). Conclusiones: Se presenta un sistema de información que posibilita la monitorización de sucesos adversos en cirugía y, a su vez, analizar los factores que se asocian a peores resultados. Aunque la mayor parte de los factores de riesgo identificados quedan fuera del control del cirujano, configuran un subgrupo de pacientes de alto riesgo en los que debería incrementarse la vigilancia

Objective: To describe adverse events after abdominal wall hernia repair and to analyze the association between these outcomes and certain characteristics of the patient and hospital admission. Material and methods: A cohort of 931 patients who underwent abdominal wall hernia repair was evaluated. Postoperative complications, reoperations and mortality were prospectively studied. Logistic regression was used to evaluate the association of complications with patient characteristics and hospital admission. Results: A total of 16.3% of patients developed postsurgical complications, mainly those related to the surgical wound, which were present in 9.3% (seroma 4%, hematoma 3.7% and infection 1.5%). Organ failure affected 1.1% of patients and intra-abdominal complications were found in less than 0.5%; 0.6% underwent reoperation during admission, 0.3% were admitted to the intensive care unit and four patients (0.4%) died in hospital. Postoperative complications were associated with age groups older than 46 years (46-65 years, odds ratio [OR] = 2.06; 66-79 years, OR = 3.11), male sex (OR = 2.06), urgent admission (OR = 1.85), regional anesthesia (OR = 1.81) and general anesthesia (OR = 1.99). Conclusions: We are introducing an information system that allows adverse outcomes in surgery to be monitored and, in turn, the factors associated with the poorest results to be analyzed. Although most of the risk factors identified were beyond the surgeon's control, a subgroup of high risk patients should undergo closer surveillance

[Adverse outcomes in the surgical treatment of acute appendicitis]. / Efectos adversos en la cirugía de la apendicitis aguda.

OBJECTIVES: To describe adverse outcomes after appendectomy for acute appendicitis and to analyze the association between these outcomes and specific characteristics of the patient and hospital admission. MATERIAL AND METHODS: We studied a cohort of 792 patients who underwent appendectomy for acute appendicitis. Postoperative complications, reoperations and deaths were prospectively studied and all readmissions were retrospectively identified. Logistic regression was used to evaluate the relationship between complications and patient characteristics, as well as hospital admission. RESULTS: Postsurgical complications developed in 9.8% of the patients. These complications mainly consisted of surgical wound infection (4.2%) and intra-abdominal complications (2.1%). A total of 0.7% of patients underwent reoperation during admission, 0.5% were admitted to the intensive care unit and five patients (0.6%) died in hospital. The rate of operation-related readmissions in the following year was 3.2%. Length of hospital stay was longer in patients with complications than in those without complications (9.6 and 3.5 days, respectively). Postoperative complications were associated with older age (45-65 years, OR 3.62, p < 0.001; more than 65 years OR 8.68, p < 0.001) and acute appendicitis complicated with peritonitis or perforation (OR 3.69, p < 0.005). Readmissions related to previous surgery were associated only with complications during the first admission (OR 18.79, p < 0.001). CONCLUSIONS: In appendectomy, the most frequent adverse outcomes are surgical wound infection and intra-abdominal complications, which are associated with older patients and perforations. This subgroup of patients at high risk requires closer surveillance.