Level III Trauma Centers Achieve Comparable Outcomes in Blunt Splenic Injury as Level I Centers.

INTRODUCTION: Identifying patients who can be safely managed in lower-level trauma centers is critical to avoid overburdening level I centers. This study examines the transfer patterns and outcomes of blunt splenic injury (BSI) patients cared for at 2 regional level III trauma centers as compared to an associated level I center. METHODS: A retrospective cohort study was conducted including all trauma patients with BSI admitted to 2 level III trauma centers (TC3) and a level I center (TC1) between 2012 and 2022. Patients were broken into 3 categories: TC1, TC3, and transfer patients (transferred from TC3 to TC1). RESULTS: A total of 1480 patients were admitted to TC1, 208 patients to TC3, and 128 were transferred. 22.7% of transfer patients were children. No difference in splenic injury grade was seen between patients managed at TC1 and TC3. Patients presenting to TC1 had more severe concomitant injuries. Patients underwent urgent splenectomy at similar rates at TC1 and TC3 (15.1 vs 18.7%, P = .1). Successful nonoperative management was achieved at similar rates (81.3 vs 75.5%, P = .1). When controlling for ISS and ED disposition, there was no significant difference in length of stay (LOS), ICU LOS, and inpatient mortality between TC1 and TC3. CONCLUSION: Level III centers effectively managed BSI achieving comparable outcomes to the level 1 center. Transfers commonly occurred in pediatric and multisystem trauma patients, though high-grade splenic injuries were not predictive of transfer. High-grade BSI can be safely managed at level III centers without need for transfer.

Causes and Timing of Unplanned ICU Admissions Among Trauma Patients at a Level 1 Trauma Center.

BACKGROUND: Unexpected ICU admissions are a key quality metric in trauma care. The purpose of this study is to identify the most common causes of unplanned ICU admissions among trauma patients at an ACS-verified level 1 trauma center. METHODS: A retrospective review was conducted of all trauma patients with unplanned admission to the ICU at a level 1 trauma center between 2019 and 2021. Unplanned ICU admissions were categorized into (1) "bounce-backs," patients previously admitted to the ICU and (2) "upgrades," patients who had not previously been cared for in the ICU. RESULTS: Of 300 unexpected ICU transfers, bounce-backs accounted for 69% and upgrades 31%. The most common injuries were traumatic brain injuries (40%) and rib fractures (41.3%). In-hospital mortality rate was 10% and did not significantly differ between bounce-backs and upgrades (12 vs 5%, P = .92). Respiratory distress was the most common cause of transfer (41.1%), followed by neurologic (29.6%) and cardiovascular decline (21.2%). Patients were on average 928 mL fluid positive 72 hours prior to transfer (t > 0, P < .0001), and 295 mL fluid positive in the 24 hours prior to transfer (t > 0, P .0003). Patients transferred for respiratory distress were no more fluid over-balanced than those transferred for other reasons. CONCLUSION: We found a large percent of unplanned transfers occurring within 48 hours of admission or transfer out of the ICU suggesting under-triage as a leading cause of bounce-backs and upgrades. Respiratory distress was the leading cause of transfer. These findings highlight opportunities for targeted interventions.

Molecular Detection and Genotyping of Cryptosporidium spp. Isolates from Bats in Colombia.

PURPOSE: Cryptosporidiosis is a zoonotic infectious disease caused by the protozoan parasite Cryptosporidium spp., frequently found in several animal species, including bats. Several Cryptosporidium genotypes have been described in bats worldwide, suggesting that bats are infected by host-specific Cryptosporidium spp. To date, there are no published reports about Cryptosporidium spp. in bats from Colombia. Therefore, this study aimed to determine the presence and molecular diversity of Cryptosporidium spp. in Colombian bats. METHODS: A total of 63 gut samples from three bat species served for molecular detection of Cryptosporidium spp. 18S rDNA gene by qPCR. The sequenced amplicons were used in subsequent phylogenetic analyses to identify them as species or genotypes. RESULTS: Cryptosporidium spp. qPCR detection occurred in 9.5% (6/63) of bat intestines, and four sequences represented two new genotypes, called Cryptosporidium bat genotypes XIX and XX, were identified. CONCLUSIONS: This study describes the detection of two novel Cryptosporidium bat genotypes, in two species of bats from a region of Colombia, requiring further studies to determine the relationhip between Cryptosporidium and bats in Colombia.

Selection of Forage Resources by Juvenile Goats in a Cafeteria Trial: Effect of Browsing Experience, Nutrient and Secondary Compound Content.

We evaluated the effect of browsing experience, nutritional quality and secondary compounds of forage resources, and the interaction between these factors on the selection and intake of goats in a cafeteria trial. Twelve juvenile Criollo goats from 7 to 9 months of age, weighing 22 ± 3 kg, were divided into two groups: (a) browser goats group (n = 6, BG), and (b) naïve goats group (n = 6, NG), formed according to their previous browsing experience (with and without, respectively). Animals were housed in individual pens. The cafeteria experiment lasted 21 days considering pen adaptation, foliage adaptation, and measurements, which included the selection index (SI) of experimental forage resources (Chesson's alpha) and their dry matter intake (DMI/Kg0.75), using a multiple Latin square design. Furthermore, correlation and regression analyses were used to assess the relationship between the aforementioned factors. The NG did not show any selection pattern, while the BG selected Piscidia piscipula and Senegalia gaumeri (p = 0.0002). The BG consumed smaller amounts of secondary compounds compared to NG (p = 0.0001). In the BG, the flavonoids affected negatively their selection (R2 = 97.51, p = 0.0001), while the DMI was affected by in vitro DM digestibility and flavonoids (R2 = 99.85; p = 0.0001). For the NG, the crude protein and organic matter contents were associated with DMI, but none had a significant relationship with SI. The BG selected and consumed forages with suitable nutritional quality avoiding those with high content of secondary compounds such as flavonoids. Conversely, NG did not show a clear pattern for their selection or intake.

Small Ruminant Production Based on Rangelands to Optimize Animal Nutrition and Health: Building an Interdisciplinary Approach to Evaluate Nutraceutical Plants.

The plant kingdom can influence the productivity and health of herbivores at different levels. However, demonstrating this process in a scientific manner entails substantial endeavors from different disciplines. In the present review, we will describe the features of a native vegetation system traditionally used by small ruminants and use its particularities to build an interdisciplinary approach to evaluate the nutraceutical properties of plants. Initially, we will establish the context of the low deciduous forest (LDF), considering some botanical and nutritional aspects, as well as the presence of plant secondary compounds (PSC) and gastrointestinal nematodes (GIN). Furthermore, we will focus on coevolutionary aspects that undoubtedly shaped the plants-nutrients-PSC-GIN-herbivore relationship. In addition, the concept of nutraceutical will be discussed to provide clarity and aspects to be considered for their evaluation. Then, ethological, agronomical, nutritional, PSC, parasitological and animal species issues are deepened placing emphasis on methodological approaches. Special focus is given to condensed tannins, as they are the fourth largest group of PSCs and the most studied in livestock sciences. Validation of the nutraceutical properties of plants from native vegetation systems should be seen as a process derived from many scientific disciplines that feed into each other in a cyclic manner.

Software educativo como material de consulta para la enseñanza de la morfofisiología del riñón / Educative software as of consultation material for the teaching of the morphophysiology of the kidney

Se realiza un software educativo en la asignatura Morfofisiología VI, sobre Riñón, que sirve como material de consulta y trabajo independiente del alumno de la carrera de Medicina. Se diagnosticaron las necesidades de aprendizaje en el tema de un grupo de estudiantes de Medicina de la Facultad Victoria de Girón, atendiendo aspectos teóricos y prácticos. Considerando las dificultades en el desarrollo del proceso docente relacionado con los medios de enseñanza para el apoyo de la docencia, y la preparación de los estudiantes de forma integral, se decide la elaboración de este software, como contribución a la asignatura, favoreciendo la actividad productiva, apropiación de los contenidos, el desarrollo del pensamiento y la independencia cognoscitiva, rasgo esencial del profesional de la medicina. Los medios se organizaron y compilaron, usando la plataforma SAdHEA Web. Se obtuvo una obra multimedia soportada en DVD, que fue evaluada favorablemente por especialistas(AU)

An educational software product on the kidney theme is made for the Morphophysiology VI subject. It serves as consultation material and independent work for the student of Medicine career. The learning needs in that subject of a group of Medicine students (Faculty Victory of Girón) were diagnosed, taking care of theoretical and practical aspects. Considering the difficulties in the development of the educational process related to means of support of teaching, and the integral preparation of the students, the elaboration of this software is decided. It means to be a contribution to the subject, favoring the productive activity, appropriation of the contents, the development of the thought, the cognitive independence, all of them essential characteristic of physicians. The means were organized and compiled using the SAdHEA Web platform. It was obtained a DVD supported multimedia, which was favorably evaluated by specialists(AU)

A randomized, prospective, parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy.

BACKGROUND: Exhaustive hemostasis is essential to successful thyroidectomy. Electrocoagulation to control bleeding has the potential risk of injuring the surrounding structures from lateral dispersion of heat. The Harmonic Scalpel (HS) cuts and coagulates simultaneously using mechanical vibration rather than high temperatures. Because its use in thyroidectomies has been limited, we sought to compare procedure parameters and complications of thyroidectomies performed using the HS with those using electrocoagulation. METHODS: Sixty patients were randomized into 2 surgical groups, HS and the standard technique using electrocautery and ligatures as the primary hemostatic method. A sample t test or Wilcoxon rank sum test was used to compare the following parameters: operative time, number of ligatures, blood loss, pain intensity, need for extra dose(s) of analgesic, incidence of recurrent laryngeal nerve palsy, and hypoparathyroidism. RESULTS: Both groups of 30 patients were comparable in age, gender, and nature of disease. In 38 patients (63%), surgery was performed for benign disease, and in 22 (37%), for differentiated carcinoma. Operative time (arithmetic mean +/- SD) was 25 minutes less in the HS group (96 +/- 23 vs 121 +/- 34, P = .005). Median number of ligatures in the HS group was 1 (range, 0-7) versus 17 (range, 6-28) ( P < .001). Mean blood loss, estimated by gauze weight, was less with HS (35 +/- 27 mL vs 54 +/- 51 mL, P = .06). Drainage during the first 24 postoperative hours and pain intensity during the first postoperative week were similar in both groups. There were no episodes of persistent nerve palsy or hypoparathyroidism in either group. CONCLUSION: The use of HS in thyroidectomies requires less operative time than does electrocoagulation.

Correlation between radiologic and pathologic dimensions of adrenal masses.

The size of adrenal tumors has been shown to be a good predictor of malignancy. There is still some controversy about the concordance between radiologic and real pathologic measurements. The aim of this study is to determine the correlation between direct and corrected radiologic computed tomography scan dimensions and the measurements of the resected specimen. A total of 41 adrenal tumors were included. Direct and corrected measurements of the largest diameter were contrasted with the pathologic dimensions. The Linos formula was used for the corrected measurements. Proper statistics were used considering a two-tailed significance level of 0.05. The intraclass correlations using direct and corrected measurements were 0.89 [95% confidence interval (95%CI) 0.81-0.94, p = 0.00001) and 0.90 (95%CI 0.82-0.95, p = 0.00001), respectively. The bivariate analysis using Pearson's correlation between two-dimensional group variables showed r = 0.82 (p < 0.0001) when direct and pathologic measurements were compared and r = 0.83 (p < 0.0001) when the corrected values were compared with the real dimensions. In this study, we demonstrate good correlation between radiologic and pathologic measurements of adrenal tumors. The Linos formula turned out to be significantly more accurate than direct radiologic measurements when means of the groups were compared, whereas when individual correlations were determined the two were similar. The Linos formula and radiologic measurements can be used to determine the proper management of adrenal incidentalomas in individual patients.

Laparoscopic Roux-en-Y gastric bypass for morbid obesity: results of our learning curve in 100 consecutive patients.

BACKGROUND: Morbid obesity requires life-long treatment, and bariatric surgery provides the best results. Among the bariatric procedures, laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been considered to be superior. However, it requires advanced laparoscopic skills and a learning curve. We analyzed our results in an initial series of 100 patients. METHODS: Data of 100 consecutive patients who underwent LRYGBP for morbid obesity in a 2.5-year period were prospectively collected and analyzed with emphasis on results and complications. RESULTS: Mean age was 31+/-5 years. There were 63 woman and 37 men. Preoperative BMI was 50+/-9 kg/m(2). 33 patients were considered super-obese (BMI>50). Mean operative time was 3.8 +/- 0.7 hours. Two patients required conversion to open surgery. Mean hospital stay was 6 days. Complications occurred in 10 patients. Mortality rate was 2%. Excess body weight loss was as follows: 33 +/- 8% at 3 months (n=92), 47 +/- 2% at 6 months (n=82), 62 +/- 4% at 1 year (n= 70), 66 +/- 5% at 18 months (n= 63) and 67 +/- 8% at 2 years (n= 35). There was significant improvement in several co-morbid conditions, such as diabetes and hypertension. CONCLUSION: LRYGBP is a reproducible technique. It requires the combination of bariatric and laparoscopic expertise.