Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: is it sustainable for the healthcare system?

INTRODUCTION: There has been a rapid proliferation of the robotic approach to inguinal hernia, mainly in the United States, as it has shown similar outcomes to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in our setting (Spanish National Health System). MATERIALS AND METHODS: A retrospective single-center comparative study on inguinal hernia repair using a robotic approach versus laparoscopic approach. RESULTS: A total of 98 patients who underwent either robotic or laparoscopic TAPP inguinal hernia repair between October 2021 and July 2023 were analyzed. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p < 0.001), an extended hospital stays (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p < 0.007), as well as higher procedural costs (2318.63 ± 205.15 € vs. 356.81 ± 110.14 €, p < 0.001) and total hospitalization costs (3272.48 ± 408.49 € vs. 1048.61 ± 460.06 €, p < 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias. CONCLUSIONS: The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.

Design and fabrication of a lightweight 3D first surface mirror aluminized by DC magnetron sputtering.

Aluminum thin films were deposited on a 3D prototype employing the direct current magnetron sputtering technique to fabricate a lightweight 3D first surface mirror. Before the aluminizing, the surface of the prototypes was evaluated with interferometry and atomic force microscope (AFM). The thin films were characterized using profilometry, UV-Vis spectroscopy, x-ray diffraction, AFM, x-ray photoelectron spectroscopy (XPS), and scanning electron microscopy. High adherence and homogeneous deposition of the aluminum's thin films were achieved. In addition, the purity of the material was confirmed by XPS analysis.

Timing of umbilical cord occlusion, delayed vs early, in preterm babies: A randomized controlled trial (CODE-P Trial).

INTRODUCTION: Our hypothesis was that delayed cord clamping (DCC) (not earlier than 30 s; at 30-60 s) in premature neonates (born between 26.0 and 32.6 weeks of gestation), as compared with the usual early cord clamping (ECC), significantly reduces the need for blood transfusions and incidence of intraventricular haemorrhage (IVH) without an increased rate of maternal postpartum haemorrhage. MATERIAL AND METHODS: A prospective, open-label, randomized, controlled trial was conducted at Vall d'Hebron Hospital from July 2014 to December 2018. All pregnant women at risk of impending preterm birth (≥26.0-<33.0 weeks of gestation) who were admitted to the obstetrics emergency department were evaluated for eligibility. If they met the eligibility criteria, they were invited to participate in the study and, if they agreed, they signed an informed consent. Patients were randomly assigned to one of two groups: ECC group and DCC group. RESULTS: Our study included a total of 57 patients: 30 in the ECC group and 27 in the DCC group. Due to a lack of funding and low recruitment rates, the study was discontinued in 2018. Maternal characteristics and obstetric outcomes were similar between both groups. The intention-to-treat analysis did not reveal any differences between groups for neonatal red blood cell transfusions, neonatal IVH or maternal postpartum haemorrhage. There were no differences for secondary outcomes. Similarly, no differences were observed in the as-treated analysis. CONCLUSION: The primary and secondary outcomes of our study were not achieved. Therefore, more meta-analysis and trials are needed to evaluate the appropriate timing of cord clamping in preterm birth.

Revisión sistemática de intervenciones de fisioterapia respiratoria y sus efectos en la función pulmonar en pacientes obesos intervenidos de cirugía bariátrica / Systematic review of Respiratory Physiotherapy interventions and their effects on lung function in obese patients operated of bariatric surgery

Introducción La incidencia de obesidad alcanza casi un tercio de la población mundial. En España habrá más de 27 millones de personas con obesidad para 2030, suponiendo una enorme carga socioeconómica, obligando a realizar intervenciones como la cirugía bariátrica (CB) que también tiene sus complicaciones. En los últimos años ha existido un avance de técnicas de fisioterapia respiratoria (FR) por ejemplo, empleando ejercicios respiratorios o utilizando presión positiva (PP). Objetivo Revisar sistemáticamente las intervenciones de FR en CB centrándonos en el tipo de intervención, momento y sus efectos sobre la función pulmonar. Metodología Se realizó la búsqueda en las bases PubMed, CINAHL y PEDro hasta marzo del 2022. Se incluyeron estudios de intervenciones de FR, que midieran la función pulmonar, en contexto pre-posquirúrgico de CB. Se excluyeron los trabajos que no aportaran datos originales, intervención no realizada por fisioterapeutas o que no miden función respiratoria. La calidad metodológica de los estudios se evaluó con la escala PEDro y JBI cheklist for cohort studies. Resultados Fueron incluidos 16 documentos, 20% presentó excelente calidad metodológica y 50% buena. El tamaño muestral varió entre 24 y 148, al igual que la edad (entre 18-60 años) incluso alcanzando 75 años en algún estudio, predominando el género femenino. El tipo de intervenciones (manuales, instrumentales o educacionales), momento de aplicación (pre y posquirúrgicas) y resultados evaluados fueron muy heterogéneos. Conclusiones Existe gran variabilidad de intervenciones de fisioterapia en CB, la mayoría (75%) mejoran la función pulmonar, otras indican falta de eficacia y algunas no indican cambios (AU)

Introduction The incidence of obesity reaches almost a third of the world population. In Spain, there will be more than 27 million people with obesity in 2030. Assuming an enormous socioeconomic burden, forcing interventions such as bariatric surgery, whit their complications. In recent years, there has been an advance in Respiratory Physiotherapy (RP) techniques, for example, using breathing exercises or using positive pressure (PP). Objective To systematically review RP interventions in bariatric surgery, focusing on the type of intervention, timing, and its effects on lung function. Methodology PubMed, CINAHL and PEDro databases were searched until March 2022. RP emergency studies were included, which measured lung function, in the pre-post-surgical context of bariatric surgery. Studies that did not provide original data, intervention not performed by physiotherapists or that did not measure respiratory function were excluded. The methodological quality of studies was evaluated with the PEDro scale and the JBI checklist for cohort studies. Results 16 documents were included, 20% presented excellent methodological quality and 50% good. The sample size varied between 24 and 148 and age (between 18-60 years), even reaching 75 years in some studies, with the female gender predominating. The type of outbreak (manual, instrumental or educational), time of application (pre and post-surgery) and results evaluated were very heterogeneous. Conclusions There is a high variability in physiotherapy interventions used in bariatric surgery, most (75%) improve lung function, others indicate lack of efficacy and some do not indicate changes (AU)

Activity of imipenem/relebactam against Enterobacterales and Pseudomonas aeruginosa in Spain. SMART 2016-2020.

OBJECTIVE: To determine susceptibility to the novel ß-lactam/ß-lactamase inhibitor combination imipenem/relebactam in clinical isolates recovered from intra-abdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream (BSI) infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study in SPAIN during 2016 - 2020. METHODS: Broth microdilution MICs for imipenem/relebactam and comparators were determined by a central laboratory against isolates of Enterobacterales and Pseudomonas aeruginosa. MICs were interpreted using EUCAST-2021 breakpoints. RESULTS: In total, 5,210 Enterobacterales and 1,418 P. aeruginosa clinical isolates were analyzed. Imipenem/relebactam inhibited 98.8% of Enterobacterales. Distinguishing by source of infection susceptibility was 99.1% in BSI, 99.2% in IAI, 97.9% in RTI, and 99.2% in UTI. Of intensive care unit isolates (ICU) 97.4% were susceptible and of non-ICU isolates 99.2% were susceptible. In Enterobacterales, activity against Class A, Class B and Class D carbapenemases was 96.2%, 15.4% and 73.2%, respectively. In P. aeruginosa, imipenem/relebactam was active in 92.2% of isolates. By source of infection it was 94.8% in BSI, 92.9% in IAI, 91.7% in RTI, and 93.1% in UTI. An 88.7% of ICU isolates and 93.6% of non-ICU isolates were susceptible to imipenem/relebactam. Imipenem/relebactam remained active against P. aeruginosa ceftazidime-resistant (76.3%), cefepime-resistant (73.6%), imipenem-resistant (71.5%) and piperacillin-resistant (78.7%) isolates. Of all multidrug-resistant or difficult-to-treat resistance P. aeruginosa isolates, 75.1% and 46.2%, respectively, were susceptible to imipenem/relebactam. CONCLUSIONS: Imipenem/relebactam showed high rates of susceptibility in Enterobacterales and P. aeruginosa isolates from different sources of infection as well as depending on patients' location (ICU or non-ICU scenarios).

Fármacos modificadores de la enfermedad en la esclerosis múltiple durante la lactancia: revisión de la evidencia actual / Disease-modifying drugs in multiple sclerosis during breastfeeding: a review of current evidence

Introducción: La esclerosis múltiple afecta principalmente a mujeres en edad fértil, y el período de gestación y posparto es de especial interés por las peculiaridades que comporta en cuanto a evolución de la enfermedad y por las consecuencias terapéuticas que se derivan. En el período de lactancia materna (LM), la elección de la estrategia de tratamiento debe poner en una balanza, por un lado, los beneficios bien establecidos de la LM para el recién nacido y su madre y, por el otro, el perfil de seguridad y potenciales efectos adversos en el lactante derivados de la exposición a los fármacos modificadores de la enfermedad, por transferencia a través de leche materna. Desarrollo: Se realiza una revisión de la evidencia actual acerca de la seguridad de los fármacos modificadores de la enfermedad disponibles para el tratamiento de la esclerosis múltiple durante el período de LM, y se recogen datos de transferencia de los diferentes fármacos a la leche materna, así como los potenciales efectos adversos descritos en el lactante. Los fármacos considerados de primera elección durante este período son el interferón beta y el acetato de glatiramer. El resto de los fármacos modificadores de la enfermedad no están aceptados para su utilización en el período de LM por ficha técnica. Sin embargo, en los últimos años, se han publicado datos de estudios de práctica clínica y series de casos que indican que algunos de estos fármacos podrían utilizarse con seguridad durante este período. Conclusiones: Teniendo en cuenta los beneficios reconocidos de la LM para la salud tanto de la madre como del lactante, se debe recomendar la LM exclusiva a las pacientes con esclerosis múltiple siempre que sea posible. Es fundamental realizar una evaluación individualizada previa al embarazo y valorar las diferentes opciones de tratamiento en función de cada paciente.(AU)

Introduction: Multiple sclerosis mainly affects women of childbearing age, and the pregnancy and postpartum period is of special interest because of the peculiarities of the disease course and the therapeutic consequences that derive from it. During the period of breastfeeding (BF), the choice of treatment strategy must weigh up the well-established benefits of BF for both the newborn and the mother against the safety profile and potential adverse effects on the infant resulting from exposure to disease-modifying drugs transferred through breast milk. Development: The study reviews the current evidence on the safety of disease-modifying drugs available for the treatment of multiple sclerosis during the BF period, and gathers data on the transfer of the different drugs into breast milk, as well as the potential adverse effects described in the infant. The drugs of first choice during this period are interferon beta and glatiramer acetate. The rest of the disease modifying drugs are not accepted for use in the BF period according to their summary of product characteristics. However, in recent years, data from studies of clinical practice and case series have been published suggesting that some of these drugs could be used safely during this period. Conclusions: Given the recognised health benefits of BF for both mother and infant, exclusive breastfeeding is recommended whenever possible. It is essential to carry out an individualised assessment prior to pregnancy and to evaluate the different treatment options depending on each patient.(AU)

[Esclerosis multiple. Lactancia. Lactante. Planificacion familiar. Posparto. Tratamiento modificador de la enfermedad.] / Fármacos modificadores de la enfermedad en la esclerosis múltiple durante la lactancia: revisión de la evidencia actual.

INTRODUCTION: Multiple sclerosis mainly affects women of childbearing age, and the pregnancy and postpartum period is of special interest because of the peculiarities of the disease course and the therapeutic consequences that derive from it. During the period of breastfeeding (BF), the choice of treatment strategy must weigh up the well-established benefits of BF for both the newborn and the mother against the safety profile and potential adverse effects on the infant resulting from exposure to disease-modifying drugs transferred through breast milk. DEVELOPMENT: The study reviews the current evidence on the safety of disease-modifying drugs available for the treatment of multiple sclerosis during the BF period, and gathers data on the transfer of the different drugs into breast milk, as well as the potential adverse effects described in the infant. The drugs of first choice during this period are interferon beta and glatiramer acetate. The rest of the disease modifying drugs are not accepted for use in the BF period according to their summary of product characteristics. However, in recent years, data from studies of clinical practice and case series have been published suggesting that some of these drugs could be used safely during this period. CONCLUSIONS: Given the recognised health benefits of BF for both mother and infant, exclusive breastfeeding is recommended whenever possible. It is essential to carry out an individualised assessment prior to pregnancy and to evaluate the different treatment options depending on each patient.

TITLE: Fármacos modificadores de la enfermedad en la esclerosis múltiple durante la lactancia: revisión de la evidencia actual.Introducción. La esclerosis múltiple afecta principalmente a mujeres en edad fértil, y el período de gestación y posparto es de especial interés por las peculiaridades que comporta en cuanto a evolución de la enfermedad y por las consecuencias terapéuticas que se derivan. En el período de lactancia materna (LM), la elección de la estrategia de tratamiento debe poner en una balanza, por un lado, los beneficios bien establecidos de la LM para el recién nacido y su madre y, por el otro, el perfil de seguridad y potenciales efectos adversos en el lactante derivados de la exposición a los fármacos modificadores de la enfermedad, por transferencia a través de leche materna. Desarrollo. Se realiza una revisión de la evidencia actual acerca de la seguridad de los fármacos modificadores de la enfermedad disponibles para el tratamiento de la esclerosis múltiple durante el período de LM, y se recogen datos de transferencia de los diferentes fármacos a la leche materna, así como los potenciales efectos adversos descritos en el lactante. Los fármacos considerados de primera elección durante este período son el interferón beta y el acetato de glatiramer. El resto de los fármacos modificadores de la enfermedad no están aceptados para su utilización en el período de LM por ficha técnica. Sin embargo, en los últimos años, se han publicado datos de estudios de práctica clínica y series de casos que indican que algunos de estos fármacos podrían utilizarse con seguridad durante este período. Conclusiones. Teniendo en cuenta los beneficios reconocidos de la LM para la salud tanto de la madre como del lactante, se debe recomendar la LM exclusiva a las pacientes con esclerosis múltiple siempre que sea posible. Es fundamental realizar una evaluación individualizada previa al embarazo y valorar las diferentes opciones de tratamiento en función de cada paciente.

Gabapentin increases the abuse liability of alcohol alone and in combination with oxycodone in participants with co-occurring opioid and alcohol use disorder.

BACKGROUND: People who have co-occurring Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD) carry a higher risk of adverse outcomes, including drug overdose. Early clinical and preclinical studies suggested that gabapentin may be effective in treating both disorders. The present study was designed to assess the effects of gabapentin on the subjective and physiological effects of oxycodone (OXY) and alcohol (ALC), alone and in combination. METHODS: During an 8-week, inpatient, within-subject, randomized, double-blind, placebo-controlled crossover study, non-treatment seeking participants (N = 13; 12 M/1F; 44.1 ± 3 years of age) with OUD and AUD were maintained on oral morphine (120 mg daily). Under gabapentin (1800 mg/day) and placebo (0 mg/day) maintenance, participants completed nine separate test sessions (three sessions per week) during which they received an oral solution containing 0, 15, or 30 mg/70 kg OXY in combination with 0, 0.5, or 0.75 g/kg ALC. During test sessions, subjective effects and physiological responses were assessed repeatedly on 100-mm visual analog scales (VAS). The primary outcome variable was the VAS rating of drug liking after receiving the drug challenge. RESULTS: Alcohol alone (but not oxycodone alone) produced dose-related increases in several positive subjective responses, including drug liking. Gabapentin significantly increased drug liking when given in combination with ALC and OXY + ALC (p < 0.05). Gabapentin did not clinically compromise respiration or other vital functions. CONCLUSIONS: Gabapentin may increase the abuse liability of ALC and OXY + ALC in those with co-occurring OUD and AUD.

The feasibility of masks and face shields designed by 3D printing makers; some considerations of their use against the COVID-19.

The use of mask and face shield has been established as one of the main preventive measures for the control of COVID 19 spread. In Mexico, as well as in other regions of the world, 3D printing has been employed for the design and production of masks and face shields as personal protective equipment (PPE). These models have been fabricated mainly by the makers, industries, and university communities; therefore, it is necessary to analyze the feasibility of the 3D printed PPE to understand its advantages and limitations. In this work, some characteristics of masks and face shields fabricated by additive manufacturing were studied to explore their viability as protection against flow fluids similar to human sneeze. In the present paper, the PPE was designed, and 3D printed utilizing three types of polylactic acid (PLA) as base material. The morphology and the surface elemental analyses of sectioned samples were analyzed by scanning electron microscopy (SEM) and energy dispersion x-ray spectroscopy (EDS). Showing spacing between printed layers, porous areas, and dispersed copper particles. On the other hand, a computational fluid dynamics (CFD) simulation was carried out, the results demonstrated the importance of using PPE for protection of a possible exposure to a "contaminated" aerosol and human sneeze. Based on the abovementioned results, it is possible to consider the commercial PLA as suitable material for the manufacturing of PPE due to its capability to be disinfected employing isopropanol, ethanol, or commercial disinfectants.

Tríada találgica. Una nueva entidad clínica a partir de una serie de casos / Thalalgic triad. A new clinical entity from a case series

Introducción: El dolor crónico en el talón es un cuadro frecuente en la patología del pie. Este tipo de cuadros no están causados por una sola lesión, sino que es el resultado de la combinación de una serie de cuadros clínicos, especialmente por una neuropatía de Baxter y una fascitis plantar. Desde hace varios años, y tras analizar una serie de casos clínicos, se observa que los pacientes con dolor crónico en el talón cursan con un proceso de fasciosis plantar, edema óseo de calcáneo o síndrome congestivo de calcáneo y neuropatía del nervio de Baxter. A raíz de este hallazgo concluimos en una nueva entidad clínica denominada tríada találgica, la cual no presenta referencias bibliográficas anteriores en la literatura científica. Pacientes y métodos: Se ha llevado a cabo una serie de casos de 10 pacientes a los que se les diagnostica una combinación de 3 patologías, denominada tríada találgica, que cursa con aparición de fasciosis plantar, edema óseo de calcáneo (congestión calcánea) y neuropatía compresiva de Baxter. Cada una de estas patologías se trata de forma independiente con distintas terapias, tales como soportes plantares, infiltraciones, tratamiento farmacológico o cirugía. Resultados: Un total de 10 mujeres con una edad media de 53 años fueron diagnosticadas de fasciosis plantar, edema óseo de calcáneo y neuropatía compresiva de Baxter mediante diferentes pruebas, como la ecografía. Estas pacientes fueron tratadas mediante infiltraciones de colágeno, extracción del líquido sanguinolento del calcáneo, terapia electrolisis percutánea intratisular, soportes plantares, tratamiento farmacológico y ondas de choque. El 40 % de la muestra se encontraba de baja laboral debido al dolor incapacitante de esta tríada y el 10 % en situación de jubilación. Conclusiones: La tríada találgica es una entidad clínica desconocida, con un diagnóstico complejo que combina pruebas complementarias con diagnóstico clínico...(AU)

Introduction: Chronic heel pain is a frequent condition in foot pathology. These types of pictures are not caused by a single injury, but are the result of a combination of a series of clinical pictures, especially Baxter's neuropathy and plantar fasciitis. For several years and after analyzing a series of clinical cases, it has been observed that patients with chronic pain in the heel present with a process of plantar fasciosis, calcaneal bone edema or congestive calcaneal syndrome and Baxter nerve neuropathy. As a result of this finding, we conclude on a new clinical entity called thatalgic triad, which does not present previous bibliographic references in the scientific literature. Patients and methods: A series of cases of 10 patients who were diagnosed with a combination of 3 pathologies, called the thatalgic triad, has been carried out, with the appearance of plantar fasciosis, calcaneal bone edema (calcaneal congestion) and neuropathy Baxter compression. Each of these pathologies is treated independently with different therapies, such as plantar supports, infiltrations, drug treatment or surgery. Results: A total of 10 women with a mean age of 53 years were diagnosed with plantar fasciosis, calcaneal bone edema and Baxter's compressive neuropathy by different tests, such as ultrasound. These patients were treated by collagen infiltrations, removal of bloody fluid from the calcaneus, intratissular percutaneous electrolysis therapy, plantar supports, pharmacological treatment, and shock waves. 40 % of the sample was on sick leave due to the disabling pain of this triad and 10 % were in retirement. Conclusions: The thatalgic triad is an unknown clinical entity with a complex diagnosis that combines complementary tests with clinical diagnosis. Likewise, there are very few bibliographic references on this subject.(AU)