Von Willebrand's disease in breast surgery: case report.

Von Willebrand disease is an inherited disorder characterized by deficiency of von Willebrand factor, which contributes to platelet adhesion to the endothelium. Patients with coagulation disorders present a challenge at the time of surgery due to the high risk of presenting heavy bleeding within the procedure or postoperative hematomas. We present a case of a 56-year-old woman with Type 1 von Willebrand's disease who was scheduled for breast explantation with autologous reconstruction, due to the presence of long-standing breast implants. The case was satisfactorily managed by a multidisciplinary team formed by plastic surgery, hematology, and anesthesiology, individualizing the management for the patient's case, obtaining good results and a safe procedure.

Impact of the armed conflict in Colombia: consequences in the health system, response and challenges.

INTRODUCTION: In Colombia, research on health and conflict has focused on mental health, psychosocial care, displacement, morbidity, and mortality. Few scientific studies have assessed health system functioning during armed conflicts. In a new period characterized by the implementation of the peace agreement with the Revolutionary Armed Forces of Colombia (FARC) armed group, understanding the effects of armed conflict on the health system, the functions, and institutions shaped by the conflict is an opportunity to understand the pathways and scope of post-conflict health policy reforms. Therefore, this study was conducted to assess the effects of armed conflict on the health system, response, and mechanisms developed to protect medical missions during armed conflict in Colombia. METHODS: This research was conducted using a qualitative approach with semi-structured interviews and focus group discussions. The qualitative guide collected information in four sections: (1) conflict and health system, effects and barriers in health service provision, (2) actions and coordination to cope with those barriers, (3) health policies and armed conflict, and (4) post-accord and current situation. Twenty-two people participated in the interviews, including eight policymakers at the national level and seven at the local level, including two NGOs and five members of international organizations. An academic project event in December 2019 and four focus groups were developed (World Cafe technique) to discuss with national and local stakeholders the effects of armed conflict on the health system and an analytical framework to analyze its consequences. RESULTS: The conflict affected the health-seeking behavior of the population, limited access to healthcare provision, and affected health professionals, and was associated with inadequate medical supplies in conflict areas. The health system implemented mechanisms to protect the medical mission, regulate healthcare provision in conflict areas, and commit to healthcare provision (mental and physical health services) for the population displaced by conflict. CONCLUSION: The state's presence, trust, and legitimacy have significantly reduced in recent years. However, it is crucial to restore them by ensuring that state and health services are physically present in all territories, including remote and rural areas.

Incidence of appendiceal neoplasms in appendectomy patients.

BACKGROUND: Non-operative management has been suggested as a therapy for uncomplicated appendicitis. Notwithstanding, the risk of missing an appendiceal tumor must be considered, being the surgical piece crucial to rule out neoplasms. Therefore, we aim to determine the incidence of appendiceal neoplasms in patients with acute appendicitis, tumor types and the importance of the anatomopathological study of the surgical piece. STUDY DESIGN: Retrospective study in which we described patients who underwent emergent appendectomy with histopathological findings of appendiceal neoplasms from January 2012 to September 2018. Descriptive analysis included demographic variables, diagnostic methods, and surgical techniques. RESULTS: 2993 patients diagnosed with acute appendicitis who underwent an emergency appendectomy. 64 neoplasms of the appendix were found with an incidence of 2,14%. 67.2% were women, the mean age was 46,4 years (± 19.5). The most frequent appendiceal neoplasms were neuroendocrine tumors (42,2%), followed by appendiceal mucinous neoplasms (35,9%), sessile serrated adenomas (18,8%), and adenocarcinomas (3,1%). In 89,1% of the cases, acute appendicitis was determined by imaging, and 14% of cases were suspected intraoperatively. Appendectomy was performed in 78,1% without additional procedures. CONCLUSIONS: Appendiceal tumors are rare and must be ruled out in patients with suspected acute appendicitis. The incidence of incidental neoplasms is higher in this study than in the previously reported series. This information must be included in decision-making when considering treatment options for acute appendicitis.

Association between clinical and surgical variables with postoperative outcomes in patients treated for intestinal obstruction for non-malignant conditions: a cross-sectional study.

Intestinal obstruction is considered a frequent surgical pathology related to previous surgical procedures. Many different factors can lead to different outcomes when surgical management is needed. Therefore, we aim to describe the factors related to morbidity and mortality in surgical management of IO in a single-center experience. Retrospective observational study with a prospective database, in which we described patients who underwent surgical management due to intestinal obstruction between 2004 and 2015. Demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. 366 patients were included. Female were 54.6%. Mean age was 61.26. Laparoscopic approach was done in 21.8% and the conversion rate was 17.2%. Intestinal resection was performed in 37.9% of the cases. Postoperative complications were observed in 18.85%. Reintervention and mortality were 9.5% and 4.1% respectively. Laparoscopic approach shows lesser time of intestinal transit (mean 28.67 vs. mean 41.95 h), and restart of oral intake after surgery (mean 96.06 vs. mean 119.65) compared with open approach. Increased heart rate and intensive care unit length of stay were related with mortality (p 0.01 and 0.000 respectively). For morbidity, laparotomy and need and duration of ICU stay were related with any complication statistically significant (p 0.02, 0.008, 0.000 respectively). Patients with increased heart rate in the emergency room, decreased amount of intravenous fluids, need and higher length of stay in the intensive care unit, and delay in resuming oral intake after surgery appear to have poor outcomes. Laparoscopic approach seems to be a safe and feasible approach for intestinal obstruction in selected patients.

Prevalencia de Hiperkalemia, factores de riesgo asociados y morbimortalidad en pacientes en Hemodiálisis / Prevalence of hyperkalemia associated risk factors and morbidity and mortality in patients on hemodialysis

RESUMEN Introducción: La muerte súbita es la principal causa de muerte en pacientes con ERC en hemodiálisis crónica (HD). Objetivo: Evaluar la prevalencia de hiperkalemia (HK) en los pacientes tratados con HD, los factores de riesgo asociados al desarrollo de la misma, y determinar su asociación con mortalidad de cualquier causa y mortalidad cardiovascular. Materiales y métodos: Estudio de cohorte retrospectiva. Se incluyeron 153 pacientes en HD. Se registró el K (potasio) sérico desde noviembre de 2020 durante 6 meses en periodo interdialítico corto. Resultados: La prevalencia de HK (K>5.1) fue de 35.3 % (n=54). Al comparar a los hiperkalemicos (HK) vs normokalemicos (NK) encontramos diferencias significativas en edad (61 vs 68 años p: 0.013), tiempo en diálisis (83 vs 51 meses p= 0.002), acceso vascular (FAV/prótesis) (88.9 vs 67.7% p= 0.016) y uso de quelantes del K (20.4 vs 4 % p= 0.003), con una tendencia a la significancia en el score de Charlson (5 vs 6 p= 0.07). En el análisis multivariado el Score de Charlson (OR: 1.36, CICI 1.19-1.55, p< 0.001) y las hospitalizaciones (OR: 5, CI 2.18-11.68, p<0.001), se asociaron a mayor mortalidad, mientras que la HK se mantuvo como un factor protector (OR: 0.287, CI 0.124-0.664 p: 0.004). Conclusión: La HK se asoció con menor edad y score de Charlson respecto a los NK. La HK resultó se asoció en forma significativa con menor mortalidad de cualquier causa.

ABSTRACT Introduction: Sudden death is the leading cause of death in patients with CKD on chronic hemodialysis (HD). Objective: To evaluate the prevalence of hyperkalemia (HK) in patients treated with HD, the risk factors associated with its development, and to determine its association with all-cause mortality and cardiovascular mortality. Materials and methods: Retrospective cohort study including 153 HD patients. Serum K (potassium) was recorded from November 2020 for six months in a short interdialytic period. Results: The prevalence of HK (K>5.1) was 35.3% (n=54). When comparing hyperkalemic (HK) vs. normokalemic (NK) patients, we found significant age differences (61 vs. 68 years p: 0.013), time on dialysis (83 vs. 51 months p= 0.002), vascular access (AVF/prosthesis) ( 88.9 vs. 67.7% p= 0.016) and use of K chelators (20.4 vs. 4% p= 0.003), with a tendency to significance in the Charlson score (5 vs. 6 p= 0.07). In the multivariate analysis, the Charlson Score (OR: 1.36, CICI 1.19-1.55, p<0.001) and hospitalizations (OR: 5, CI 2.18-11.68, p<0.001) were associated with higher mortality, while HK remained as a protective factor (OR: 0.287, CI 0.124%E2%80%930.664 p: 0.004). Conclusion: HK was associated with lower age and Charlson scores than NK. HK was significantly associated with lower all-cause mortality.

Variations in clinical course and surgical outcomes of acute appendicitis during COVID-19 Pandemic: a multicenter cohort study.

BACKGROUND: COVID-19 pandemic has led to changes in the presentation and treatment of surgical pathologies. Therefore, we aim to describe the influence of the COVID-19 pandemic on the clinical presentation and management of acute appendicitis (AAp) and its surgical outcomes. STUDY DESIGN: A multicenter cohort study with prospectively collected databases. Three high-volume centers were included and all patients over 18 years of age who underwent appendectomy for AAp were included. Multiple logistic regression and multinomial logistic regression were performed, and odds ratio, relative risk, and B-coefficient were reported when appropriate, statistical significance was reached with p-values < 0.05. RESULTS: 1.468 patients were included (709 in the pre-pandemic group and 759 in the COVID-19 group). Female patients constituted 51.84%. Mean age was 38.13 ± 16.96 years. Mean Alvarado's score was 7.01 ± 1.59 points. Open surgical approach was preferred in 90.12%. Conversion rate of 1.29%. Mortality rate was 0.75%. There was an increase of perforated and localized peritonitis (p 0.01) in the COVID-19 group. Presence of any postoperative complication (p 0.00), requirement of right colectomy and ileostomy (p 0.00), and mortality (p 0.04) were higher in the COVID-19 group. Patients in the pre-pandemic group have a lesser risk of mortality (OR 0.14, p 0.02, 95% CI 0.02-0.81) and a lesser relative risk of having complicated appendicitis (RR 0.68, p 0.00, 95% CI 0.54-0.86). CONCLUSION: Complicated appendicitis was an unexpected consequence of the COVID-19 pandemic, due to surgical consultation delay, increased rates of morbidity, associated procedures, and mortality, influencing the clinical course and surgical outcomes of patients with AAp.

Meckel's diverticulum: analysis of 27 cases in an adult population.

Background: Meckel's diverticulum is a rare congenital pathology among newborns. Nevertheless, it is an uncommon abdominal pathology in the adult population. Therefore, we aim to provide a detailed account of our surgical approach in treating 27 cases of Meckel's diverticulum. Methods: This study is a cross-sectional analysis that utilized a database with prospectively collected data from 2004 to 2022. All patients under the age of 18 were excluded from the population. We described the population's demographic characteristics, symptoms, anatomopathological study, surgical technique, complications, morbidity, and mortality. A subgroup analysis was performed between the symptomatic and asymptomatic patients. Results: A total of 27 patients who underwent surgical resection for a posteriorly diagnosed Meckel's diverticulum were included. The male population accounted for 81.4% (n = 22) of the sample size. The symptomatic group consisted of 18 male and four female patients. Abdominal pain was the predominant symptom in 85% of the patients. Out of the 22 symptomatic patients, only 9% had a positive perioperative diagnosis of Meckel's diverticulum. All 27 patients with diverticulum diagnosis received the resection through diverticulectomy (n = 6), small bowel resection with end-to-end anastomosis (n = 6), and small bowel resection with lateral to lateral anastomosis (n = 15). The mean distance between the diverticulum and the ileocecal valve was 63.4 cm. The symptomatic group had an average diverticulum length of 3.54 cm, with an average base width of 2.47 cm. In the other group, the values were 2.75 and 1.61 cm. The average length of hospital stay in the symptomatic group was 7.3 days. Conclusions: Meckel's diverticulum is a rare pathology in the adult population. Its presentation varies from asymptomatic to symptomatic patients, and surgery is the cornerstone treatment for this pathology.

Transversus abdominis release (TAR) procedure: a retrospective analysis of an abdominal wall reconstruction group.

Complex abdominal wall defects are important conditions with high morbidity, leading to impairment of patients' physical condition and quality of life. In the last decade, the abdominal wall reconstruction paradigm has changed due to the formation of experienced and excellence groups, improving clinical outcomes after surgery. Therefore, our study shows the perspective and outcomes of an abdominal wall reconstruction group (AWRG) in Colombia, focused on the transverse abdominis release (TAR) procedure. A retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent TAR procedures between January 2014-December 2020 were included. Analysis and description of postoperative outcomes (recurrence, surgical site infection (SSI), seroma, hematoma, and re-intervention) were performed. 47 patients underwent TAR procedure. 62% of patients were male. Mean age was 55 ± 13.4 years. Mean BMI was 27.8 ± 4.5 kg/m2. Abdominal wall defects were classified with EHS ventral Hernia classification having a W3 hernia in 72% of all defects (Mean gap size of 11.49 cm ± 4.03 cm). Mean CeDAR preoperative risk score was 20.5% ± 14.5%. Preoperative use of BOTOX Therapy (OR 1.0 P 0.00 95% CI 0.3-1.1) or pneumoperitoneum (OR 0.7 P 0.04 95% CI 0.3-0.89) are slightly associated with postoperative hematoma. In terms of hernia relapse, we have 12% of cases; all of them over a year after the surgery. TAR procedure for complex abdominal wall defects under specific clinical conditions including emergency scenarios is viable. Specialized and experienced groups show better postoperative outcomes; further studies are needed to confirm our results.

Postoperative outcomes of minimally invasive adrenalectomy: do body mass index and tumor size matter? A single-center experience.

BACKGROUND: Since Gagner performed the first laparoscopic adrenalectomy in 1992, laparoscopy has become the gold-standard procedure in the treatment of adrenal surgical diseases. A review of the literature indicates that the rate of intra- and postoperative complications are not negligible. This study aims to describe the single-center experience of adrenalectomies; and explore the associations between body mass index (BMI) and tumor volume in main postoperative outcomes. METHODS: Retrospective observational study with a prospective database in which we described patients who underwent adrenalectomy between January 2015 and December 2020. Operative time, intraoperative blood loss, conversion rate, complications, length of hospital stay, and comparison of the number of antihypertensive drugs used before and after surgery were analyzed. Analysis of BMI and tumor volume with postoperative outcomes such as anti-hypertensive change (AHC) in drug usage and pre-operative conditions were performed. RESULTS: Forty-five adrenalectomies were performed, and all of them were carried out laparoscopically. Four were performed as a robot-assisted laparoscopy approach. Nineteen were women and 26 were men. Mean age was 54.9 ± 13.8 years. Mean tumor volume was 95.698 mm3 (3.75-1010.87). Mean operative time was shorter in right tumors (2.64 ± 0.75 h) than in left tumors (3.33 ± 2.73 h). Pearson correlation was performed to assess the relationship between BMI and AHC showing a direct relationship between increased BMI and higher change in anti-hypertensive drug usage at postoperative period r(45) = 0.92, p > 0.05 CI 95%. Higher tumor volume showed a longer operative time, r(45) = 0.6 (p = 0.000 CI 95%). CONCLUSIONS: Obese patients could have an increased impact with surgery with an increased change in postoperative anti-hypertensive management. Tumor volume is associated with increased operative time and blood loss, our data suggest that it could be associated with increased rates of morbidity. However, further prospective studies with larger sample sizes are needed to validate our results.

Intestinal Paracoccidioidomycosis: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Paracoccidioidomycosis (PCM) is a systemic fungal infection, primarily affecting the respiratory tract. Extra pulmonary presentation is rare, representing less than 1% of cases (about 1 in every 200 cases). CASE PRESENTATION: We present a case of a 73-year-old male with acute surgical abdomen secondary to Intestinal Paracoccidioidomycosis requiring intestinal resection and postoperative antifungal therapy. CONCLUSION: Intestinal Paracoccidioidomycosis represents a rare pathology with challenging diagnostic approach due to its frequency and nonspecific clinical manifestations. Extra pulmonary presentation is rare, but it should be considered in endemic regions.

Morbimortality assessment in abdominal surgery: are we predicting or overreacting?

BACKGROUND: High-risk surgical procedures represent a fundamental part of general surgery practice due to its significant rates of morbidity and mortality. Different predictive tools have been created in order to quantify perioperative morbidity and mortality risk. POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity) is one of the most widely validated predictive scores considering physiological and operative variables to precisely define morbimortality risk. Nevertheless, seeking greater accuracy in predictions P-POSSUM was proposed. We aimed to compare POSSUM and P-POSSUM for patients undergoing abdominal surgery. METHODS: A retrospective observational study with a prospective database was conducted. Patients over 18 years old who complied with inclusion criteria between 2015 and 2016 were included. Variables included in the POSSUM and P-POSSUM Scores were analyzed. Descriptive statistics of all study parameters were provided. The analysis included socio-demographic data, laboratory values ​​, and imaging. Bivariate analysis was performed. RESULTS: 350 Patients were included in the analysis, 55.1% were female. The mean age was 55.9 ± 20.4 years old. POSSUM revealed a moderated index score in 61.7% of the patients, mean score of 12.85 points ± 5.61. 89.1% of patients had no neoplastic diagnosis associated. Overall morbidity and mortality rate was 14.2% and 7.1%. P-POSSUM could predict more precisely mortality (p < 0.00). CONCLUSIONS: The POSSUM score is likely to overestimate the risk of morbidity and mortality in patients with high/moderate risk, while the P-POSSUM score seems to be a more accurate predictor of mortality risk. Further studies are needed to confirm our results.

Biphasic synovial sarcoma of the hypopharynx: Case report and literature review.

INTRODUCTION: Synovial Sarcoma is a rare malignancy that accounts between 8 and 10% of soft tissue neoplasms, with the highest presentation rate in extremities, an extremely uncommon condition in head and neck. CLINICAL FINDINGS: We present a case of an 18-year-old male with synovial sarcoma situated at hypopharynx who underwent surgical resection and postoperative radiotherapy. CONCLUSION: Synovial Sarcoma represents a rare head and neck malignancy with challenging diagnostic approach due to its frequency and nonspecific clinical manifestations. Surgical treatment must assure good free margins. Adjuvant radiotherapy has a positive impact in local recurrence and survival.

Escala de conocimientos, comodidad, abordaje y actitud hacia la sexualidad en personas con lesión medular: validación y adaptación al español / Knowledge, Comfort, Approach and Attitude to wards sexuality scale in spinal cord injured population: Adaptation and validation to Spanish language

Introducción. La alteración de la función sexual es una secuela común posterior a una lesión de la médula espinal. No existen escalas validadas en idioma español para evaluar conocimientos, comodidad, abordaje y actitudes del personal de salud hacia la sexualidad en pacientes con trauma de médula espinal. Objetivo. Validar la escala Knowledge, Comfort, Approach and Attitude towards Sexuality Scale (KCAASS) al idioma español. Materiales y métodos. El proceso incluyó la traducción, retrotraducción, la adaptación cultural, la validez de apariencia y contenido de la escala en profesionales involucrados con la rehabilitación sexual del paciente con lesión medular en Colombia. Un total de 122 profesionales participaron para establecer la validez del constructo y la confiabilidad. Resultados. El comité de expertos determinó que la versión en español de la escala evalúa conocimientos, comodidad, abordaje y actitud hacia la sexualidad en el paciente con lesión de médula espinal, por parte de los profesionales de la salud. En cuanto relevancia, claridad y suficiencia, el índice de validez de contenido fue mayor de 0,8 en el 75,6% de los ítems y para el 100 % de los dominios. El valor del alfa de Cronbach general fue 0,95 y el análisis factorial evidenció valores propios por encima de 1,5 en 4 factores. Conclusión. La versión en español de la escala KCAASS cuenta con una adecuada confiabilidad, validez de apariencia, contenido y constructo y puede ser utilizada para evaluar las necesidades de formación en dominios específicos de los profesionales del área de rehabilitación sexual de las personas con lesión medular.

Introduction. Impaired sexual function is a common sequela following spinal cord injury. There are no validated scales in Spanish language to assess knowledge, comfort, approach and attitudes of health personnel towards sexuality in patients with spinal cord trauma. Objective. To validate the Knowledge, Comfort, Approach and Attitude towards Sexuality Scale (KCAASS) in Spanish. Materials and methods. The process included translation, back-translation, cultural adaptation, face and content validity of the scale in professionals involved in the sexual rehabilitation of patients with spinal cord injury in Colombia. A total of 122 professionals participated to establish construct validity and reliability.Results. The expert committee determined that the Spanish version of the scale evaluates knowledge, comfort, approach and attitude towards sexuality in the patient with spinal cord injury by health professionals. In terms of relevance, clarity and sufficiency, the content validity index was greater than 0.8 in 75.6% of the items and for 100% of the domains. The overall Cronbach's alpha value was 0.95 and the factor analysis showed eigenvalues above 1.5 in 4 factors. Conclusion. The Spanish version of the KCAASS scale has adequate reliability, face, content and construct validity and can be used to assess the training needs in specific domains of professionals in the area of sexual rehabilitation of people with spinal cord injury.

Verrucous psoriasis in a male patient with a history of vulgar psoriasis: Case report and literature review / Psoriasis verrugosa en un hombre con antecedentes de psoriasis en placa, reporte de caso y revisión de la literatura

Verrucous psoriasis is an atypical and rare variant of psoriasis, with few cases reported in the literature, characterized by the presence of simetric hypertrofic and verrucous plaques on the limbs and trunk. We present the case of a 63 year old male patient with a history of vulgar psoriasis 20 years ago, in treatment with topical steroids, who has been presenting for 10 years a verrucous plaque in the distal third of the posterior aspect of the leg. Biopsy of the lesión is performed with a diagnostic impression of squamous cell carcinoma (verrucous), but the histopathologic study shows compatible changes with a verrucous psoriasis, ruling out the presence of malignancy

La psoriasis verrugosa es una variante atípica y poco frecuente de la psoriasis, con pocos casos reportados en la literatura. Se caracteriza por la presencia de placas hipertróficas y verrugosas simétricas en extremidades y tronco. Se presenta el caso de un paciente de 63 años con diagnóstico de psoriasis en placa 20 años atrás, tratado con esteroide tópico y quien 10 años antes había desarrollado una placa de aspecto verrugoso en el tercio distal de la cara posterior de la pierna izquierda. Se tomó la biopsia de la lesión por sospecha de un carcinoma escamocelular (verrugoso). El estudio histopatológico mostró cambios indicativos de psoriasis verrugosa y descartó la presencia de malignidad.

Integration of phlebotomine ecological niche modelling, and mapping of cutaneous leishmaniasis surveillance data, to identify areas at risk of under-estimation.

INTRODUCTION: Passive surveillance systems are thought to under-estimate the true incidence of American cutaneous leishmaniasis (ACL) by two- to five-fold. Ecological niche models based on remotely sensed data can identify environmental factors which favor phlebotomine vectors. Here we report an integrated approach to identifying areas at risk of cutaneous leishmaniasis by applying spatial analysis methods to niche model results, and local surveillance data, in two locations in Colombia with differing vector ecology. The objective was to identify townships in which later phases of the project could implement community-based surveillance to obtain direct estimates of under-reporting. MATERIALS AND METHODS: The study was carried out in one municipality in each of two departments of the Andean region of Colombia: Pueblo Rico in Risaralda, and Rovira in Tolima. Niche mapping by maximum entropy, based on published and unpublished existing locations of Pintomyia (Pifanomyia) longiflocosa and Psychodopygus panamensis, and using variables on land cover, climate and elevation. Field catches were done in each municipality to test predictions of high relative probability of presence. The niche model results were included as a predictor in a conditional autoregressive spatial model, in which the outcome variable was the number of cases by township, as detected by passive surveillance. RESULTS: Having rarefied 173 geolocated records, 46 of Pi. longiflocosa and 57 of Ps. panamensis were used for the niche modelling. At the national level, both species had high relative probability of presence on parts of the slopes of the three Andean cordilleras. Pi. longiflocosa also has a high relative probability of presence in the higher parts of the Magdalena valley, as does Ps. panamensis in some areas close to the Caribbean coast. At the local level, field catches confirmed that Pi. longiflocosa was the most abundant species in Rovira, and likewise Ps. panamensis in Pueblo Rico. The spatial regression showed that the incidence of ACL, according to surveillance, was positively, but not statistically significantly, associated with the relative probability of presence from the risk model. CONCLUSIONS: These niche maps bring together published and unpublished results on phlebotomine species which are important vectors in Colombia. Maps of the fitted values of incidence were used to guide the selection of townships in which further phases of the study will attempt to quantify the extent of under-estimation of ACL incidence.

Psoriasis verrugosa en un hombre con antecedentes de psoriasis en placa, reporte de caso y revisión de la literatura / Verrucous psoriasis in a male patient with a history of vulgar psoriasis: Case report and literature review

Resumen La psoriasis verrugosa es una variante atípica y poco frecuente de la psoriasis, con pocos casos reportados en la literatura. Se caracteriza por la presencia de placas hipertróficas y verrugosas simétricas en extremidades y tronco. Se presenta el caso de un paciente de 63 años con diagnóstico de psoriasis en placa 20 años atrás, tratado con esteroide tópico y quien 10 años antes había desarrollado una placa de aspecto verrugoso en el tercio distal de la cara posterior de la pierna izquierda. Se tomó la biopsia de la lesión por sospecha de un carcinoma escamocelular (verrugoso). El estudio histopatológico mostró cambios indicativos de psoriasis verrugosa y descartó la presencia de malignidad.

Abstract Verrucous psoriasis is an atypical and rare variant of psoriasis with few cases reported in the literature. It is characterized by the presence of symmetric hypertrophic and verrucous plaques on the limbs and trunk. We present the case of a 63-year-old male patient with a history of vulgar psoriasis for 20 years who was receiving treatment with topical steroids and had developed a verrucous plaque in the distal third of the posterior aspect of the leg 10 years before. We conducted a biopsy of the lesion to confirm or discard the diagnostic impression of squamous cell carcinoma (verrucous). The histopathological study showed changes compatible with verrucous psoriasis ruling out the presence of malignancy.

Outcomes of 207 totally extraperitoneal hernia repairs using self-fixation mesh.

Inguinal hernia (IH) repair is one of the most common procedures in general surgery around the world. Minimizing postoperative acute and chronic pain without increasing recurrence has been a critical point, giving place to different strategies like self-fixation mesh. The current study aimed to describe a group of patients who underwent IH repair by Totally Extraperitoneal (TEP) technique with self-gripping mesh at a fourth level hospital between 2012 and 2019. Retrospective review of a prospectively collected database including patients who underwent laparoscopic TEP approach with self-fixation mesh for IH repair. Follow up data was obtained at 12, 24, 36, 48, and 60 months post surgical intervention. 207 hernia repairs were performed in 142 patients, with a total of 66 patients with bilateral IH. 10.6% required hospitalization due to either concomitant procedure performed or cardiovascular comorbidities, with a mean hospital stay of 1.6 days. Median and late follow up was up to 5 years. 88.9% of patients complete a year, 86% two years, and 36.7% with a 5 year follow-up. IH repair using the TEP technique and self-fixation mesh showed to be an excellent approach, demonstrating satisfactory results in follow up and complications.

Hill Modified, a Novel Approach: Technique Description and Experience in Patients with Laparoscopic Sleeve Gastrectomy.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common disease among patients with obesity, with an associated prevalence of 39 to 61% between the population who attends a bariatric surgery evaluation. Laparoscopic sleeve gastrectomy (LSG) has become a popular and valid option for obesity treatment, even though the literature is ambivalent regarding the increase or decrease in GERD after this surgery. Thus, it is necessary to propose new surgical techniques as a solution to GERD in patients with a concomitant LSG or with a history of it. Therefore, we present a modified technique based on Hill's gastropexy described originally in 1967. OBJECTIVE: Describe and propose a surgical procedure for GERD management based on the Hill technique that can be applied in all patients who undergo an LSG or with a history of it. METHODS: Retrospective observational study with a prospective database in which we described, Hill modified technique in a group of 16 patients with GERD who underwent this procedure concomitantly with an LSG or who presented with GERD after LSG with a 3-year follow-up. The surgical technique is based on an intra-abdominal esophageal length of a minimum of 3 cm and posterior fixation of the gastroesophageal junction to the crus. RESULTS: Postoperative controls have shown satisfactory results in the control and management of GERD symptoms in this group of patients, with very few to no complications associated with the procedure and without reintervention or medication out of the standard protocol. CONCLUSION: Hill modified technique can be used and presented as an option for GERD control in patients with LSG.

Land use in relation to composition and abundance of phlebotomines (Diptera: Psychodidae) in five foci of domiciliary transmission of cutaneous leishmaniasis in the Andean region of Colombia.

American cutaneous leishmaniasis is a public health concern in Colombia, its incidence being sustained or focally increased principally by the emergence of domestic transmission concomitantly with the adaptation of the phlebotomine vectors to habitat transformation around households. The objective of the study is to scale up a rapid characterization methodology for evaluating the relationship of land use around the house to the composition and abundance of phlebotomines. Five sites with a history of domestic leishmaniasis transmission in the Andean area of Colombia were selected. The peri-domestic habitat was evaluated at 10 m intervals along eight radial transects, centered on each house, at 45° intervals using a web pattern. Phlebotomines were captured by placing three CDC light traps over two nights both indoors and outdoors (10 m from the house). Blood source and infection were determined by PCR. Spearman rank correlation coefficients and negative binomial regression were used to quantify associations between the phlebotomine abundance and habitat categories. The study demonstrated that the vectors were largely anthropophagic (62% of 79 were human blood) and that a single species in each site was favored by the pertaining agriculture monoculture. Specifically, Pintomyia (Pifanomyia) quasitownsendi was associated with sugar cane in Novillero and La Esmeralda; while Pi. (Pif.) longiflocosa was associated with coffee plantations in Agua Bonita and El Cucal. Honda Alta had a more diverse array of land use and forest coverage with a lower number of specimens but higher species diversity. In terms of distance from the house to an area of a given land use, the abundance of Pi. (Pif.) quasitownsendi was inversely related to the distance to sugar cane plantation (Spearman correlation coefficient, ρ = -0.56, p < 0.001 for outdoor catches, and ρ = -0.50, p < 0.001 indoors). A similar inverse relationship was observed for Pi. (Pif.) longiflocosa with regard to technified coffee (ρ = -0.51, p < 0.001 outdoors, and ρ = -0.48, p < 0.001 indoors). This rapid characterization methodology could guide public heath decision makers in identifying those houses at higher risk of domestic transmission, and also educate farmers to increase the distance between their crops and any neighboring houses.