Postoperative Abdominal Bulge and Hernia Rates in Patients Undergoing Abdominally Based Autologous Breast Reconstruction: Systematic Review and Meta-Analysis.

ABSTRACT: Bulge and hernia may occur after abdominally based breast reconstruction. The purpose of this study is to provide an estimate of the effects that the type of flap used for breast reconstruction (ie, transverse rectus abdominis muscle [TRAM] vs muscle-sparing [MS]-2 TRAM vs DIEP) has on the postoperative development of both abdominal bulge and abdominal hernia, taking into consideration the method of donor site closure (ie, with mesh vs without mesh), based on the available literature. Twenty-eight studies met the inclusion criteria and were included in the systematic review. From these, 9 studies were comparative and suitable for meta-analysis. The results showed that, for unilateral breast reconstructions, there was no statistically significant difference in hernia/bulge rates in the following techniques: MS-2 TRAM flap without mesh, MS-2 TRAM flap with mesh, and DIEP flap without mesh, and they showed significantly lower hernia/bulge rates compared with TRAM flap without mesh, and TRAM flap with mesh, whereas for bilateral reconstructions, there was no statistically significant difference in hernia/bulge rates in the following techniques: MS-2 TRAM flaps with mesh and DIEP flaps without mesh, and they showed significantly lower hernia/bulge rates compared with TRAM flaps without mesh, TRAM flaps with mesh, and MS-2 TRAM flaps without mesh.

Caracterización clinicoepidemiológica de las infecciones asociadas a la atención sanitaria en niños y adolescentes / Clinical and epidemiological characterization of the infections associated with the health care in children and adolescents

Se realizó un estudio descriptivo y transversal de 43 pacientes menores de 19 años, con infecciones asociadas a la atención sanitaria, ingresados en el Hospital General Docente "Juan B. Viñas González" de Palma Soriano, en la provincia de Santiago de Cuba, durante el período 2011-2013, con vistas a caracterizarlas desde el punto de vista clinicoepidemiológico. Los datos fueron procesados mediante el programa estadístico SPSS, versión 11.0 y se utilizó el porcentaje como medida de resumen para variables cualitativas. En la serie predominaron los lactantes, el uso previo de antimicrobianos, así como las infecciones en las vías respiratorias; asimismo, los servicios de Respiratorio y de Terapia Intensiva, resultaron ser los de mayor incidencia y tasa de infección, respectivamente.

A descriptive and cross sectional study of 43 patients under 19 years, with infections associated with the health care, admitted in "Juan B. Viñas González" Teaching General Hospital from Palma Soriano was carried out in Santiago de Cuba province, during the period 2011-2013, with the objective of characterizing them from the clinical and epidemiological point of view. The data were processed by means of the statistical program SPSS, version 11.0 and the percentage was used as summary measure for qualitative variables. In the series the newborns, the previous use of antimicrobials, as well as the infections in the airways prevailed; also, the services of Respiratory Diseases and of Intensive Therapy, turned out to be those of higher infection rate.

Sugammadex: presente y futuro / Sugammadex: present and future

Introducción: Uno de los principales problemas en anestesiología es que el despertar del paciente y la recuperación de su actividad neuromuscular no se producen al unísono. La nueva ciclodextrina llamada Sugammadex, supone un nuevo enfoque farmacológico, revolucionario y totalmente distinto al procedimiento actual en la reversión del efecto de los bloqueadores neuromusculares no despolarizantes. Objetivos: Realizar una puesta al día en cuanto a lo que este fármaco representa para la farmacología neuromuscular y su aplicación. Desarrollo: Se consultó una amplia y actualizada literatura sobre este novedoso agente reversor de la relajación muscular. Conclusiones: Sin tentaciones apresuradas, todo indica que se abre un camino espectacular que puede cambiar la forma de utilizar los relajantes musculares en un futuro próximo.

Introduction: One of the major problems in anesthesiology is that the patient's wake and recovery of her neuromuscular activity are not produced at the same time. The new Cyclodextrin called Sugammadex, entails a new pharmacologic approach , revolutionary and completely different to present procedure in reversion of the non-depolarization neuromuscular blockers effect. Objectives: To update on the representation of this drug for the neuromuscular pharmacology and its application. Development: Authors made an extensive and updated review of the literature on this novel reversion agent of muscular relaxation. Conclusions: Without hurried temptations, all indicates that a new route is appearing that may to change the way of utilization of the muscular relaxing agents in a near future.

Apnea obstructiva del sueño. Hora de ser tomado en serio por los anestesiólogos / Sleep obstructive apnea is a serious matter that must to be considered by anesthesiologists

Introducción: El mantenimiento de la permeabilidad de las vías aéreas superiores es una preocupación compartida por los anestesiólogos y por los médicos involucrados con los disturbios del sueño. Los pacientes con apnea obstructiva del sueño son más susceptibles de presentar obstrucción de las vías respiratorias, principalmente cuando se asocian al efecto depresor de fármacos usados en sedación o anestesia. Objetivo: Realizar una puesta al día sobre la relación entre apnea obstructiva del sueño y anestesia, así como planificar la conducta anestésica y tratamiento perioperatorio. Desarrollo: Se describe la conducta perioperatoria de los pacientes con apnea obstructiva del sueño que requieren uso de anestesia por cualquier causa. Conclusiones: La apnea obstructiva del sueño es una entidad que aumenta el riesgo quirúrgico y que requiere consideraciones especiales en todas las fases de la anestesia.

Introduction: High airways permeability maintenance is a concern shared by anesthesiologists and by physicians involved in sleep disturbances. Patients presenting with sleep obstructive apnea are more liable to present airways obstruction, mainly when are associated with depressor effect of drugs used in sedation or analgesia procedures. Aim: To make an updating on relation between sleep obstructive apnea and anesthesia, as well as how to plan the anesthetetic behavior of patients with this condition requiring the use of anesthesia from any cause. Conclusions: Sleep obstructive apnea is an entity increasing the surgical risk and requiring special considerations in all anesthesia phases.

Immunization with a recombinant fowlpox virus expressing a hepatitis C virus core-E1 polyprotein variant, protects mice and African green monkeys (Chlorocebus aethiops sabaeus) against challenge with a surrogate vaccinia virus.

HCV (hepatitis C virus) is a worldwide health problem nowadays. No preventive vaccine is available against this pathogen, and therapeutic treatments currently in use have important drawbacks, including limited efficacy. In the present work a recombinant fowlpox virus, FPCoE1, expressing a truncated HCV core-E1 polyprotein, was generated. FPCoE1 virus generally failed to elicit a humoral immune response against HCV antigens in BALB/c mice. By contrast, mice inoculated with FPCoE1 elicited a positive interferon-gamma secretion response against HCV core in ex-vivo ELISPOT (enzyme-linked immunospot) assays. Remarkably, mice inoculated with FPCoE1 significantly controlled viraemia in a surrogate challenge model with vvRE, a recombinant vaccinia virus expressing HCV structural antigens. In fact, 40% of the mice had no detectable levels of vvRE in their ovaries. Administration of FPCoE1 in vervet monkeys [Chlorocebus (formerly Cercophitecus) aethiops sabaeus] induced lymphoproliferative response against HCV core and E1 proteins in 50% of immunized animals. Monkeys immunized with FPCoE1 had no detectable levels of vvRE in their blood, whereas monkeys inoculated with FP9, the negative control virus, had detectable levels of vvRE in blood up to 7 days after challenge. In conclusion, recombinant fowlpox virus FPCoE1 is able to induce an anti-HCV immune response in mice and monkeys. This ability could be rationally employed to develop effective strategies against HCV infection by using FPCoE1 in combination with other vaccine candidates or antiviral treatments.