Endoscopic ultrasound (EUS)-guided cholecystostomy versus percutaneous cholecystostomy (PTC) in the management of acute cholecystitis in patients unfit for surgery: a systematic review and meta-analysis.

BACKGROUND AND AIM: Surgical cholecystectomy is the gold standard strategy for the management of acute cholecystitis (AC). However, some patients are considered unfit for surgery due to certain comorbid conditions. As such, we aimed to compare less invasive treatment strategies such as endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and percutaneous gallbladder drainage (PT-GBD) for the management of patients with AC who are suboptimal candidates for surgical cholecystectomy. METHODS: A comprehensive search of multiple electronic databases was performed to identify all the studies comparing EUS-GBD versus PT-GBD for patients with AC who were unfit for surgery. A subgroup analysis was also performed for comparison of the group undergoing drainage via cautery-enhanced lumen-apposing metal stents (LAMS) versus PT-GBD. The outcomes included technical and clinical success, adverse events (AEs), recurrent cholecystitis, reintervention, and hospital readmission. RESULTS: Eleven studies including 1155 patients were included in the statistical analysis. There was no difference between PT-GBD and EUS-GBD in all the evaluated outcomes. On the subgroup analysis, the endoscopic approach with cautery-enhanced LAMS was associated with lower rates of adverse events (RD = - 0.33 (95% CI - 0.52 to - 0.14; p = 0.0006), recurrent cholecystitis (- 0.05 RD (95% CI - 0.09 to - 0.02; p = 0.02), and hospital readmission (- 0.36 RD (95% CI-0.70 to - 0.03; p = 0.03) when compared to PT-GBD. All other outcomes were similar in the subgroup analyses. CONCLUSIONS: EUS-GBD using cautery-enhanced LAMS is superior to PT-GBD in terms of safety profile, recurrent cholecystitis, and hospital readmission rates in the management of patients with acute cholecystitis who are suboptimal candidates for cholecystectomy. However, when cautery-enhanced LAMS are not used, the outcomes of EUS-GBD and PT-GBD are similar. Thus, EUS-GBD with cautery-enhanced LAMS should be considered the preferable approach for gallbladder drainage for this challenging population.

Seguridad y eficacia del drenaje guiado por endosonografía de colecciones pancreáticas usando prótesis plásticas y metálicas tipo LAMS / Safety and efficacy of EUS-guided drainage of pancreatic fluid collections using plastic and lumen apposing metal stents (LAMS)

Background: Pancreatic fluid collections (PFC) are associated with severe acute pancreatitis. After maturation (after 4 weeks) they are classified as pancreatic pseudocyst (PP) and walled-off necrosis (WON). Endoscopic management is associated with lower morbidity and mortality compared with surgery. Aim: To describe the experience of EUS-guided drainage PFC drainage using plastic stent (PS) or metal stent (lumen apposing metal stents, or "LAMS"). Methods: Retrospective, observational study, between 2016-2019. Results: 17 patients in total. 8 cases were symptomatic PP and 9 were WON. Age 12-72 years. 12 cases in men. Indications: abdominal pain 5 cases and infection 11. The 8 cases of PFC were drained successfully using PS, without adverse effects. Regarding WON drainage, 3 cases were managed with PS and 6 with LAMS. In 5 cases, complementary endoscopic necrosectomy was required. A patient with LAMS required complementary surgical cleaning ("step-up") to treat collections far from the LAMS. Complications: one case of PS presented pigment occlusion with superinfection and another case presented migration to the stomach. Regarding LAMS, one case presented self-limited bleeding, another case presented obstruction of the stent with infection, which was managed endoscopically and with antibiotics. Conclusion: The endoscopic management of PFC is effective and safe, with plastic and metal stent (LAMS). The choice of type of stent depends on the characteristics of PFC (liquid vs solid), center experience and costs.

Introducción: Las colecciones pancreáticas (CP) se asocian a pancreatitis agudas graves. Luego de su maduración (después de las 4 semanas) se clasifican en pseudoquistes (PQ) y necrosis encapsulada (NE). El manejo endoscópico se asocia a menor morbimortalidad comparado con el quirúrgico. Objetivo: Describir la experiencia del drenaje de CP mediante el uso de prótesis plásticas (PP) o metálicas (lumen apposing metal stents, o "LAMS") mediante endosonografía. Método: Estudio retrospectivo, observacional, entre 2016-2018. Resultados: 17 pacientes en total. Ocho casos fueron PQ sintomáticos y 9 NE. Edad 12-72 años (12 casos en hombres). Indicaciones: dolor abdominal 5 casos e infección 11. Los 8 casos de PQ fueron drenados exitosamente con PP, sin efectos adversos. En relación con el drenaje de NE, 3 casos fueron manejados con PP y 6 con LAMS. En 5 casos se requirió necrosectomía endoscópica complementaria. Un paciente con LAMS requirió aseo quirúrgico complementario por colecciones alejadas al LAMS. En relación con las complicaciones, un caso de PP presentó oclusión del pigtail con sobreinfección y otro presentó migración al estómago. Respecto a LAMS, un caso presentó sangrado autolimitado y otro caso obstrucción de la prótesis con sobreinfección, que fue manejada endoscópicamente y con antibióticos. Conclusión: El manejo endoscópico de las CP es efectiva y segura, tanto con prótesis plásticas como metálicas (LAMS). La elección de la prótesis depende de las características de la lesión (líquido vs sólido), experiencia del centro y costos.

Consumo e desempenho de ovinos alimentados com silagens de cana-de-açúcar tratadas com óxido de cálcio e cloreto de sódio / Intake and performance of lambs fed with sugarcane silages treated with whitewash and sodium chloride

Avaliaram-se o consumo e o desempenho de ovinos alimentados com silagens de cana-de-açúcar tratadas com óxido de cálcio (CaO) e cloreto de sódio (NaCl). Utilizaram-se sete tratamentos: controle (silagem sem aditivo), silagens com 0,5; 1,0 e 1,5% de CaO e silagens com 0,5; 1,0 e 2,0% de NaCl, com quatro repetições. Os animais consumiram maior quantidade de matéria seca e de nutrientes digestíveis totais quando se adicionou 0,5% de NaCl ou ainda 1,0 e 1,5% de CaO. Quanto à fibra em detergente neutro e à proteína bruta, observou-se maior consumo quando se adicionou 0,5% de NaCl ou 1,0% de CaO. Não foi observado efeito da dieta sobre o ganho médio diário de peso. A adição de 0,5% de cloreto de sódio e 1,0% de óxido de cálcio à silagem de cana-de-açúcar resultou em aumento no consumo e melhora no desempenho de ovinos.

The intake and performance of lambs fed with sugarcane silages treated with whitewash and chloride sodium were evaluated. Seven treatments were used: untreated silage (control); silages treated with 0.5; 1.0 and 1.5% of CaO (whitewash); and silages treated with 0.5; 1.0 and 2.0% of NaCl, with four replicates per treatment. The animals were fed a higher amount of dry matter and total digestible nutrients when the sugarcane silages were treated with 0.5% of NaCl, 1.0 and 1.5% of CaO. The intake of neutral detergent fiber and crude protein increased when the lambs were fed silages treated with 0.5% of NaCl and 1.0% of CaO. The average daily gain did not differ among treatments. The inclusion of 0.5% of sodium chloride and 1.0% of whitewash in sugarcane silages increased the intake and improved the performance of lambs.

Consumo e desempenho de ovinos alimentados com silagens de cana-de-açúcar tratadas com óxido de cálcio e cloreto de sódio / Intake and performance of lambs fed with sugarcane silages treated with whitewash and sodium chloride

Avaliaram-se o consumo e o desempenho de ovinos alimentados com silagens de cana-de-açúcar tratadas com óxido de cálcio (CaO) e cloreto de sódio (NaCl). Utilizaram-se sete tratamentos: controle (silagem sem aditivo), silagens com 0,5; 1,0 e 1,5% de CaO e silagens com 0,5; 1,0 e 2,0% de NaCl, com quatro repetições. Os animais consumiram maior quantidade de matéria seca e de nutrientes digestíveis totais quando se adicionou 0,5% de NaCl ou ainda 1,0 e 1,5% de CaO. Quanto à fibra em detergente neutro e à proteína bruta, observou-se maior consumo quando se adicionou 0,5% de NaCl ou 1,0% de CaO. Não foi observado efeito da dieta sobre o ganho médio diário de peso. A adição de 0,5% de cloreto de sódio e 1,0% de óxido de cálcio à silagem de cana-de-açúcar resultou em aumento no consumo e melhora no desempenho de ovinos.(AU)

The intake and performance of lambs fed with sugarcane silages treated with whitewash and chloride sodium were evaluated. Seven treatments were used: untreated silage (control); silages treated with 0.5; 1.0 and 1.5% of CaO (whitewash); and silages treated with 0.5; 1.0 and 2.0% of NaCl, with four replicates per treatment. The animals were fed a higher amount of dry matter and total digestible nutrients when the sugarcane silages were treated with 0.5% of NaCl, 1.0 and 1.5% of CaO. The intake of neutral detergent fiber and crude protein increased when the lambs were fed silages treated with 0.5% of NaCl and 1.0% of CaO. The average daily gain did not differ among treatments. The inclusion of 0.5% of sodium chloride and 1.0% of whitewash in sugarcane silages increased the intake and improved the performance of lambs.(AU)

Contenidos de Anatomía en Diseños de Aprendizaje Dispuestos en LAMS e Integrado a Moodle / Anatomy Contents in Learning Designs Displayed in LAMS and Integrated to Moodle

Este trabajo trata la experiencia del uso de LAMS en procesos de aprendizaje e-learning para el área de la salud. Se trabajó con contenidos de anatomía del hígado humano, siguiendo estándares educativos y metodologías necesarias para crear Diseños de Aprendizaje (LD) y recursos educativos de calidad e interoperables. El Instituto de Anatomía, Histología y Patología fue responsable del diseño e implementación de Objetos de Aprendizaje (OAs) en anatomía de hígado (con Macromedia flash), mientras el Instituto de Informática se encargó de abordar la gestión y proceso del recurso pedagógico, integrando un especialista (LAMS y Moodle) para el diseño y gestión de aprendizaje. LAMS fue usado para crear actividades de aprendizaje basado en LD integrado a Moodle, como parte de un curso de estudiantes de medicina. La encuesta de satisfacción aplicada a estos estudiantes mostró, que casi el 70 por ciento de ellos consideró las actividades y objetivos comprensibles y suficientemente detallados, que las evaluaciones fueron coherentes con los contenidos y que existe aprendizaje colaborativo. Así mismo el 67 por ciento aseguró que volvería a usar un plan de lección en esta modalidad y sólo un 33 por ciento lo haría ocasionalmente.

This work relates to the experience of using LAMS in e-learning learning processes in the area of Health Sciences. This work was developed for the target subject matter of Human Liver Anatomy, following educational standards and the necessary methodologies to create Learning Designs (LD) and high-quality, interoperable, educational resources.The Institute of Anatomy, Histology, and Pathology was in charge of the design and implementation of the Learning Objects (LOs) in Liver Anatomy (using Macromedia Flash), while the Informatics Institute was in charge of the administration and processing of the pedagogical resource, integrating a specialist (LAMS and Moodle) for learning design and management. LAMS was used to create learning activities based on a Moodle integrated LD, as part of a medical students course. The satisfaction questionnaire applied tothese students showed that nearly 70 percent of them considered the activities and objectives to be comprehensible and at the right level of detail, the evaluations to be coherent with the subject matter of the course, and in their opinion there was collaborative learning. Likewise, 67 percent assured that they would use a lesson plan in this modality again, and only 33 percent said they would do it occasionally.

Comportamiento docente del Proyecto ELAM en la Facultad de Ciencias Médicas de Sancti Spíritus / Teaching behavior of the LAMS Project at the Faculty of Medical Sciences of Sancti Spiritus

La extensión del Proyecto ELAM a la Facultad de Ciencias Médicas de Sancti Spíritus desde septiembre del 2001 motivó la realización de un estudio a partir del ciclo clínico, del comportamiento docente de los estudiantes provenientes de la Escuela Latinoamericana de Medicina. El estudio comprendió los cursos 2001-2002, 2002-2003 y el primer semestre del curso 2003-2004. Los principales países representados en esta Facultad son Bolivia, Ecuador, México y Uruguay. La promoción ordinaria acumulada en los 2 primeros cursos presentó resultados similares, siempre por debajo del 70(por ciento). El análisis correspondiente al curso 2003-2004 evidenció resultados superiores en cada uno de los grupos de estudiantes por países. Se determinó el índice académico que osciló entre 3,50 y 4,75. Las asignaturas con mayores dificultades fueron Propedeútica y Psicología. El índice de calidad hallado reflejó que solamente el primer curso se comportó por debajo de 4,00; en los siguientes cursos, dicho índice estuvo por encima de 4,00 en todos los grupos de alumnos por países, lo cual indicó un aprovechamiento docente adecuado

The extension of the LAMS Project to the Faculty of Medical Sciences of Sancti Spiritus since September 2001, led to the conduction of a study based on the clinical cycle of the teaching behavior of the students from the Latin American Medical School. The study comprised the courses 2001-2002, 2002-2003, and the first semester of the course 2003-2004. The main countries represented in this Faculty are Bolivia, Ecuador, Mexico and Uruguay. The ordinary promotion accumulated in the two first courses presented similar results, always under 70 %, The analysis co rresponding to the course 2003-2004 evidenced higher results in each group of students by country. The academic index oscillated between 3.50 and 4.75. The most difficult subjects were Propedeutics and Psychology. According to the quality index found, only the first course behaved under 4. In the following courses, this index was over 4 in all the groups of students by country, which represented an adequate teaching development.