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.

Assessment by proxy of the SF-36 and WHO-DAS 2.0. A systematic review.

BACKGROUND AND OBJECTIVE: In some cases, for the evaluation of the health status of patients it is not possible to obtain data directly from the patient. The objective of this study was to determine if the instruments that cannot be applied to the patient can be completed by a proxy. METHODS: A systematic review of the literature was carried out and 20 studies were included. The instruments reviewed in this synthesis were: Short Form-36 (SF-36), Montreal Cognitive Assessment (MoCA), WHODAS 2.0, Patient Health Questionnaire 9 (PHQ-9), State-Trait Anxiety Inventory (STAI), Disability Rating Scale (DRS). RESULTS: The levels of agreement between the responses of the patients and the proxies were good, mainly when evaluating HRQoL and functioning with the SF-36 and WHODAS 2.0 instruments, respectively, with a higher level of agreement in the more objective and observable domains such as physical functioning and lower level of agreement in less objective domains, such as emotional or affective status, and self-perception. CONCLUSION: In patients who cannot complete the different instruments, the use of a proxy can help avoid the omission of responses.

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.

Colangiopancreatografía retrógrada endoscópica asistida por enteroscopia de doble balón en un paciente con gastrectomía total y reconstrucción en Y-de-Roux: reporte de caso / Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in a patient with total gastrectomy and roux-en-y reconstruction: A case report

Resumen La colangiopancreatografía retrógrada endoscópica (CPRE) es un procedimiento útil en el manejo de enfermedades biliopancreáticas. Los pacientes con alteración anatómica del tracto gastrointestinal representan un desafío técnico por múltiples razones. Con técnicas como la enteroscopia de doble balón (EDB) es posible realizar una CPRE en estos pacientes. El caso que se presenta es el primero de este tipo publicado en Colombia sobre una paciente con gastrectomía total con reconstrucción en Y-de-Roux y coledocolitiasis.

Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable procedure in managing biliopancreatic diseases. Patients with anatomical alteration of the gastrointestinal tract represent a technical challenge for multiple reasons. With techniques such as double-balloon enteroscopy (DBE), it is possible to perform ERCP in these patients. The case was first published in Colombia on a female patient with total gastrectomy with Roux-en-Y reconstruction and choledocholithiasis.

Neuroprotective and Regenerative Effects of Growth Hormone (GH) in the Embryonic Chicken Cerebral Pallium Exposed to Hypoxic-Ischemic (HI) Injury.

Prenatal hypoxic−ischemic (HI) injury inflicts severe damage on the developing brain provoked by a pathophysiological response that leads to neural structural lesions, synaptic loss, and neuronal death, which may result in a high risk of permanent neurological deficits or even newborn decease. It is known that growth hormone (GH) can act as a neurotrophic factor inducing neuroprotection, neurite growth, and synaptogenesis after HI injury. In this study we used the chicken embryo to develop both in vitro and in vivo models of prenatal HI injury in the cerebral pallium, which is the equivalent of brain cortex in mammals, to examine whether GH exerts neuroprotective and regenerative effects in this tissue and the putative mechanisms involved in these actions. For the in vitro experiments, pallial cell cultures obtained from chick embryos were incubated under HI conditions (<5% O2, 1 g/L glucose) for 24 h and treated with 10 nM GH, and then collected for analysis. For the in vivo experiments, chicken embryos (ED14) were injected in ovo with GH (2.25 µg), exposed to hypoxia (12% O2) for 6 h, and later the pallial tissue was obtained to perform the studies. Results show that GH exerted a clear anti-apoptotic effect and promoted cell survival and proliferation in HI-injured pallial neurons, in both in vitro and in vivo models. Neuroprotective actions of GH were associated with the activation of ERK1/2 and Bcl-2 signaling pathways. Remarkably, GH protected mature neurons that were particularly harmed by HI injury, but was also capable of stimulating neural precursors. In addition, GH stimulated restorative processes such as the number and length of neurite outgrowth and branching in HI-injured pallial neurons, and these effects were blocked by a specific GH antibody, thus indicating a direct action of GH. Furthermore, it was found that the local expression of several synaptogenic markers (NRXN1, NRXN3, GAP-43, and NLG1) and neurotrophic factors (GH, BDNF, NT-3, IGF-1, and BMP4) were increased after GH treatment during HI damage. Together, these results provide novel evidence supporting that GH exerts protective and restorative effects in brain pallium during prenatal HI injury, and these actions could be the result of a joint effect between GH and endogenous neurotrophic factors. Also, they encourage further research on the potential role of GH as a therapeutic complement in HI encephalopathy treatments.

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.

Molecular detection of Toxoplasma gondii in meat for human consumption in Ibague, Colombia / Detección molecular de Toxoplasma gondii en carnes para consumo humano en Ibagué, Colombia

Introduction: Toxoplasma gondii is a parasite with great zoonotic potential. It can infect a broad range of warm-blooded hosts (including livestock) and causes significant losses in the industry. In humans, it has been described as a pathogen in immunosuppressed people, it affects the fetus development in congenital infections, and is associated with various behavioral disorders in healthy people. Humans can acquire T. gondii by consuming undercooked, contaminated meat. Objective: To determine T. gondii positivity (currently unknown) in meat for human consumption (i.e., beef, chicken, and pork) in the city of Ibague, Colombia. Materials and methods: We used conventional nested PCR and the T. gondii B1 gene sequence as amplification target. We collected samples of meat (N=186) sold in the urban area of Ibagué (62 beef, 62 chicken, and 62 pork samples) and determined the T. gondii positivity percentage for each type of meat. Results: The study found an average of 18.8% positivity for all meat samples, pork having the highest percentage (22.5%; 14/62), followed by beef (19.3%; 12/62) and chicken (14.5%; 9/62). The best-amplified products were sequenced by macrogen and aligned with the B1 gene sequences in GenBank, thereby confirming their identity. Conclusions: This is the first study of T. gondii prevalence in meat for human consumption carried out in the city of Ibagué and the department of Tolima. All three types of meat sampled represent a risk for local human infection

Introducción. Toxoplasma gondii es un parásito con gran potencial zoonótico que puede infectar un amplio rango de huéspedes de sangre caliente, incluidos los animales del sector pecuario, lo que causa pérdidas a la industria. En el humano, es patógeno en personas inmunosuprimidas y afecta el desarrollo del feto en infecciones congénitas. Además, se asocia con diversos trastornos del comportamiento en personas sanas. El humano puede adquirir T. gondii al consumir carnes contaminadas mal cocidas. Objetivo. Determinar la positividad de T. gondii en carnes de consumo humano (res, pollo y cerdo) en Ibagué, Colombia. Materiales y métodos. Se utilizó la PCR convencional anidada y la secuencia del gen B1 de T. gondii como blanco de amplificación. Se tomaron 186 muestras de carne comercializada en la zona urbana de Ibagué (62 de res, 62 de pollo y 62 de cerdo) y se obtuvo el porcentaje de positividad en cada tipo de carne evaluada. Resultados. Se encontró un porcentaje de positividad de 18,8 % en las muestras, siendo la carne de cerdo la del mayor porcentaje (22,5 %; 14/62), seguida por las muestras de carne de res (19,3 %; 12/62) y de pollo (14,5 %; 9/62). Los mejores productos amplificados fueron secuenciados en Macrogen, y alineados con las secuencias del gen B1 depositadas en el GenBank, con lo que se confirmó su identidad. Conclusiones. Este es el primer estudio sobre prevalencia de T. gondii en carnes para consumo humano en Ibagué y el departamento del Tolima. Se demostró que los tres tipos de carne representan un riesgo para la infección en humanos a nivel local.

Conocimientos, actitudes y prácticas sobre toxoplasmosis en dos comunas de Armenia, Quindío, con alta prevalencia de la infección / Knowledge, attitudes, and practices related to toxoplasmosis in two districts of high prevalence in Armenia, Quindío / Conhecimentos, atitudes e práticas sobre toxoplasmose em duas comunas de Armenia, Quindío, com alta prevalência de infecção

Resumen Objetivo: Describir los conocimientos, las actitudes y las prácticas acerca de la toxoplasmosis en dos comunas de Armenia, Quindío, con alta prevalencia de la infección. Metodología: Estudio descriptivo con población de dos comunas de Armenia, Quindío. Se aplicó un cuestionario autodiligenciado tipo conocimientos, actitudes y prácticas. Esta herramienta incluyó elementos sobre el parásito Toxoplasma gondii, sus vías de transmisión, aspectos clínicos, diagnósticos y de tratamiento generales, así como prácticas para evitar la infección. El instrumento se aplicó antes y después de una intervención educativa. Se describieron las frecuencias en el número de respuestas correctas antes y después de la intervención para cada comuna. Resultados: Participaron 27 personas, con una media de edad de 57 años. El 59 % fueron mujeres. El 48% había completado la educación media y el 40,7 % la primaria. El conocimiento del agente causal antes de la intervención fue del 22 %, mientras que posterior a la intervención fue del 92,3 % en la comuna 1 y del 81,8 % en la comuna 6. Posterior a la intervención, cerca del 90 % de los encuestados reconoció la retina como la principal estructura afectada y todos los encuestados reconocieron el consumo de agua hervida como factor protector. Conclusión: Los conocimientos sobre la toxoplasmosis en las dos comunas eran limitados. Luego de la intervención educativa, se evidenció un aumento en el porcentaje de respuestas correctas en la mayoría de las preguntas. Se recomienda realizar nuevas intervenciones educativas y en salud pública, para evaluar los efectos de estas a largo plazo.

Abstract Objective: To describe knowledge, attitudes and practices related to toxoplasmosis in two districts of high prevalence in Armenia, Quindío. Methodology: descriptive study; the population of two districts of Armenia, Quindío were engaged. A self-administered questionnaire regarding knowledge, attitudes, and practices was applied. This tool included elements related to Toxoplasma gondii, its transmission pathways, general clinical, diagnostic and treatment aspects, as well as practices to prevent infection. The instrument was applied before and after an educational intervention. Frequencies were described as the number of correct answers before and after the intervention for each district. Results: 27 people participated, with an average age of 57 years. 59 % were women; 48 % had completed high school and 40.7 % had completed elementary school. Before the intervention, the knowledge of the causal agent was 22 %, while after the intervention, it was 92.3 % in district 1 and 81.8 % in district 6. After the intervention, about 90 % of participants recognized the retina as the main compromised structure and all participants recognized the consumption of boiled water as a protective factor. Conclusion: The knowledge regarding toxoplasmosis in the two districts was limited. After the educational intervention, there was an increase in the percentage of correct answers in most of the questions. New educational and public health interventions are recommended to assess the long-term effects of these interventions.

Resumo Objetivos: O objetivo deste estudo é descrever os problemas, as ações e as práticas sobre a toxoplasmose nas comunidades da Armênia, Quindío, onde se nota alta prevalência da infecção. Metodologia: Este é um estudo descritivo que abrange uma população de duas comunas na Armênia, Quindío. Foi implementada uma ferramenta, que consiste em questionários destinados àquela população e aplicáveis pelos seus próprios membros, que correspondem a conhecimentos, atitudes e práticas. Essa ferramenta inclui elementos sobre o parasito Toxoplasma gondii, suas vias de transmissão, aspectos clínicos gerais, diagnósticos e tratamento, e práticas de prevenção. O instrumento foi aplicado antes e após uma intervenção educativa exata. Foram descritas as frequências do número de acertos, antes e depois da intervenção para cada comuna. Resultados: participaram 27 pessoas, com média de idade de 57 anos, das quais 59 % eram mulheres e 48 % tinham ensino médio completo e 40,7 % ensino primário. O conhecimento do agente causal antes da intervenção havia em 22 %, enquanto que após a intervenção, passou para 92,3 % na comuna 1, e 81,8 % na comuna 6. Após a intervenção, cerca de 90 % dos entrevistados reconheceram a retina como a estrutura mais afetada e todos os entrevistados reconheceram que o consumo de água fervida é um fator de proteção. Conclusão: Desconhecimento sobre a toxoplasmose nas duas comunas. Após a intervenção educativa, houve evidência de aumento do percentual de acertos na maioria das questões. Recomenda-se a realização de novas intervenções educacionais e de saúde pública, para avaliar os efeitos destas a longo prazo na populacão.

Growth Hormone (GH) Enhances Endogenous Mechanisms of Neuroprotection and Neuroplasticity after Oxygen and Glucose Deprivation Injury (OGD) and Reoxygenation (OGD/R) in Chicken Hippocampal Cell Cultures.

As a classical growth promoter and metabolic regulator, growth hormone (GH) is involved in development of the central nervous system (CNS). This hormone might also act as a neurotrophin, since GH is able to induce neuroprotection, neurite growth, and synaptogenesis during the repair process that occurs in response to neural injury. After an ischemic insult, the neural tissue activates endogenous neuroprotective mechanisms regulated by local neurotrophins that promote tissue recovery. In this work, we investigated the neuroprotective effects of GH in cultured hippocampal neurons exposed to hypoxia-ischemia injury and further reoxygenation. Hippocampal cell cultures obtained from chick embryos were incubated under oxygen-glucose deprivation (OGD, <5% O2, 1 g/L glucose) conditions for 24 h and simultaneously treated with GH. Then, cells were either collected for analysis or submitted to reoxygenation and normal glucose incubation conditions (OGD/R) for another 24 h, in the presence of GH. Results showed that OGD injury significantly reduced cell survival, the number of cells, dendritic length, and number of neurites, whereas OGD/R stage restored most of those adverse effects. Also, OGD/R increased the mRNA expression of several synaptogenic markers (i.e., NRXN1, NRXN3, NLG1, and GAP43), as well as the growth hormone receptor (GHR). The expression of BDNF, IGF-1, and BMP4 mRNAs was augmented in response to OGD injury, and exposure to OGD/R returned it to normoxic control levels, while the expression of NT-3 increased in both conditions. The addition of GH (10 nM) to hippocampal cultures during OGD reduced apoptosis and induced a significant increase in cell survival, number of cells, and doublecortin immunoreactivity (DCX-IR), above that observed in the OGD/R stage. GH treatment also protected dendrites and neurites during OGD, inducing plastic changes reflected in an increase and complexity of their outgrowths during OGD/R. Furthermore, GH increased the expression of NRXN1, NRXN3, NLG1, and GAP43 after OGD injury. GH also increased the BDNF expression after OGD, but reduced it after OGD/R. Conversely, BMP4 was upregulated by GH after OGD/R. Overall, these results indicate that GH protective actions in the neural tissue may be explained by a synergic combination between its own effect and that of other local neurotrophins regulated by autocrine/paracrine mechanisms, which together accelerate the recovery of tissue damaged by hypoxia-ischemia.

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.

Behavior of acute myocardial infarctions in an intensive care unit of a medium-size city over a one-year span / Comportamiento del infarto agudo de miocardio en una unidad de cuidado intensivo de una ciudad intermedia durante un año

Abstract Objectives: to identify the clinical and paraclinical behavior of myocardial infarctions in an intensive care unit of a medium-size city during 2017. Methods: a descriptive, cross-sectional study which included 99 medical records with a diagnosis of myocardial infarction on ICU discharge. The variables were described and analysis of variance and Chi2tests were performed, using a p-value less than 0.05 for statistically significant differences. Results: the prevalence of myocardial infarction in the ICU was 11.8%. The average age was 66.8 years. Chest pain was present in 82.8% with an average duration of 335 minutes. The pain most often radiated to the left arm (13.1%). Non-ST segment elevation myocardial infarction was the most frequent (50.5%), and the electrocardiogram located the infarctions on the inferior surface in 28.2%. The average ultrasensitive troponin I was 28.2 ng/mL. A total of 54.5% had complications. Mortality was 14.1%. Hospital stay was 6.5 and critical care stay was three days. There was a statistically significant relationship between chest pain and ST segment elevation (p<0.001) and between troponin I plus hospital stay and ST segment elevation (p=0.007 and p=0.003, respectively). Conclusion: the study showed that 11.8% of patients admitted to ICU are admitted for myocardial infarction, and there is a statistically significant relationship between chest pain and an elevated ST segment and between increased troponin I plus a longer hospital stay and ST segment elevation. (Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1498).

Resumen Identificar el comportamiento clínico y paraclínico del infarto de miocardio en una unidad de cuidados intensivos de una ciudad intermedia durante el 2017. Métodos: estudio descriptivo de corte transversal, incluyó 99 registros con diagnóstico de infarto del miocardio al egreso de UCI. Se describieron las variables y se realizaron análisis de varianza y chi2y se consideró un valor de p<0.05 para diferencias estadísticamente significativas. Resultados: la prevalencia de infarto del miocardio fue 11.8% en UCI. La edad promedio fue 66.8 años. El dolor precordial estuvo presente en 82.8% con una duración promedio de 335 minutos. La irradiación del dolor fue más frecuente a miembro superior izquierdo (13.1%). El infarto sin elevación del complejo ST fue más frecuente (50.5%). Y la localización electrocardiográfica fue en la cara inferior en 28.2%. El promedio de troponina I ultrasensible fue de 28.2 ng/mL. Presentaron complicaciones el 54.5%. La mortalidad fue de 14.1%. La estancia hospitalaria fue 6.5 y la estancia en cuidados críticos tres días. Se encontró relación estadísticamente significativa entre dolor precordial y elevación del segmento ST (p<0.001) y entre troponina I con estancia hospitalaria y elevación del segmento ST (p=0.007 y p=0.003 respectivamente). Conclusión: se identificó que 11.8% de los pacientes que ingresan a la UCI, lo hacen por infarto del miocardio, y una relación estadísticamente significativa entre dolor precordial con elevación del segmento ST y entre el aumento de troponina I con mayor estancia hospitalaria y elevación del segmento ST.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1498).

Colecistectomía total en colecistitis complicada: ¿es una conducta segura? / Total cholecystectomy in complicated cholecystitis: is it a safe conduct?

Introducción. La colecistectomía es uno de los procedimientos más comunes en cirugía general y que produjo la explosión de la laparoscopia a finales de los años 80. Una de las complicaciones más temida es la lesión de la vía biliar, en especial en la colecistitis complicada, por lo que la Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) promueve la estrategia de colecistectomía segura. Se presenta una serie de casos que muestra la frecuencia de las lesiones de la vía biliar en las colecistectomías complicadas (grados II y III de la clasificación de Tokio). Materiales y métodos. Se configuró una serie de casos con pacientes a quienes un cirujano general experto en laparoscopia les practicó colecistectomía laparoscópica en el Hospital Universitario Fundación Santa Fe de Bogotá en un periodo de dos años, de enero de 2016 a marzo de 2018. El objetivo era establecer la frecuencia de lesiones de la vía biliar durante la colecistectomía. Resultados. Se identificaron 56 pacientes con colecistitis complicada, 2 (3,57 %) de ellas, Tokio III. Se encontró una frecuencia de complicaciones de 1,78 %, sin evidenciar lesión de la vía biliar. Discusión. La incidencia de lesión de la vía biliar en nuestra población no es superior a la informada, entre 0,2 y 0,4 %, sin necesidad de una colecistectomía subtotal por laparoscopia en la gran mayoría de ellas. En el futuro, debe considerarse el desarrollo de criterios para establecer cuándo se requiere un procedimiento quirúrgico abreviado

Introduction: Cholecystectomy is one of the most common procedures performed in general surgery and was responsible for the dissemination of laparoscopy among surgeons starting in the late 1980's. One of the most feared complication is bile duct injury, particularly in complicated cholecystitis. That is why SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) has promoted a safe cholecystectomy program. A case series of complicated cholecystectomies and the frequency of complications is presented. Materials and methods: This case series enrolled patients who underwent laparoscopic cholecystectomy at the University Hospital Fundación Santa Fe de Bogotá (Bogotá, Colombia) in the two year period from January 2016 to March 2018 by a single surgeon with laparoscopic expertise. The outcome sought was bile duct injury. Results: Fifty-six patients were identified as having complicated cholecystitis, two of them (3.57%) being Tokyo III. The frequency of complication in our study reported 1.78%, none of them a bile duct injury. Discussion: In our study bile duct injury incidence was not superior to the one reported in international literature, 0.2-0.4%, without performing a subtotal cholecystectomy. In the future, it is worth considering the development of a set of criteria to define when an abbreviated procedure is indicated

Mimicking Neural Stem Cell Niche by Biocompatible Substrates.

Neural stem cells (NSCs) participate in the maintenance, repair, and regeneration of the central nervous system. During development, the primary NSCs are distributed along the ventricular zone of the neural tube, while, in adults, NSCs are mainly restricted to the subependymal layer of the subventricular zone of the lateral ventricles and the subgranular zone of the dentate gyrus in the hippocampus. The circumscribed areas where the NSCs are located contain the secreted proteins and extracellular matrix components that conform their niche. The interplay among the niche elements and NSCs determines the balance between stemness and differentiation, quiescence, and proliferation. The understanding of niche characteristics and how they regulate NSCs activity is critical to building in vitro models that include the relevant components of the in vivo niche and to developing neuroregenerative approaches that consider the extracellular environment of NSCs. This review aims to examine both the current knowledge on neurogenic niche and how it is being used to develop biocompatible substrates for the in vitro and in vivo mimicking of extracellular NSCs conditions.

Investigación en el sistema da Vinci en el hospital St Mary's de Londres / Investigation in the system da Vinci in the hospital St Mary' s of London

Hipótesis: El sistema robótico da Vinci™ permite superar las limitaciones que impone al cirujano la cirugía mínimamente invasora en términos de destreza, control del campo operatorio y ergonomía.Los estudios incluidos en esta compilación evalúan la curva de aprendizaje, la visión en tercera dimensión y el análisis de movimientos, con el propósito de comprobar las ventajas del sistema da Vinci sobre la cirugía mínimamente invasora y establecer métodos de evaluación de desempeño. Métodos: Sistema: da Vinci™. Tres estudios experimentales comparativos con diez y trece cirujanos quienes realizaron diferentes pruebas. Estudiaron: curva de aprendizaje entre cirujanos experimentados/ no experimentados, ventajas de visión 3D sobre 2D y de cirugía robótica (CR) sobre cirugía mínimamente invasora. Evaluación de mediciones: el desempeño de los cirujanos se midió con una escala global de habilidades y medición de errores. Calificación: a ciegas por expertos; además se empleó un software de análisis de movimiento para cirugía mínimamente invasora y para cirugía robótica, ambos desarrollados en el departamento y previamente validados en otros estudios. Cálculos estadísticos: programa Statistical Package for Social Sciences 10,0™. p<0,05.Resultados: La curva de aprendizaje reveló un puntaje de valoración objetiva y estructurada de destrezas técnicas de 18 (primer intento) contra 26 (quinto) p=0,02 Cronbach µ=0,894. El análisis de movimiento mostró reducción del numero de movimientos y trayectoria (p>0,01). La comparación de cirugía mínimamente invasora con cirugía robótica mostró reducción del 40 por ciento del tiempo (p=0,001) y de 70 por ciento de la trayectoria (p=0,008) con reducción de 93 por ciento de errores. La visión 3D demostró ser superior a 2D en esta y otras pruebas. La comparación entre cirugía laparoscópica y robótica en dos estudios mostró ventajas para el da Vinci.Conclusión: Los instrumentos articulados, la abolición del temblor, los movimientos a escala reducida y la visión 3D del da Vinci mejoran la habilidad y desempeño del cirujano en cirugía mínimamente invasora asistida por robot...

Fundoplicatura parcial anterior: revision sistematica / Partial anterior fundoplication systematic review

Aunque la técnica quirúrgica más utilizada para el tratamiento de la enfermedad por reflujo gastroesofágico es la fundoplicatura de Nissen por laparoscopia, la tasa de complicaciones y secuelas parece ser más alta que la de diferentes clases de fundoplicaturas parciales. El objetivo de este artículo es revisar el conocimiento existente de la fundoplicatura parcial anterior, y tratar de establecer una comparación con la fundoplicatura de Nissen, considerada como el patrón oro. Una revisión sistemática de la literatura reveló únicamente un estudio controlado aleatorizado, un estudio comparativo prospectivo y un número pequeño de series de casos. El análisis sugirió que las dos técnicas logran un adecuado control del reflujo y la esofagitis y que son seguras y eficaces. Aparentemente existe una posible ventaja para la fundoplicatura anterior en cuanto a complicaciones y secuelas postoperatorias, pues hay menor disfagia, distensión abdominal e inhabilidad para eructar o vomitar. Los artículos revisados permiten concluir que la fundoplicatura anterior por lo menos es igual de segura y eficaz en el control de la enfermedad por reflujo gastroesofágico al Nissen y que puede tener menos secuelas postoperatorias y ser mejor aceptada por los pacientes. Sin embargo, se necesitan más reportes de estudios controlados aleatorizados con seguimiento a largo plazo para poder sugerir un cambio en las recomendaciones actuales