Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques.

BACKGROUND: Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques -sinusectomy (SE) and pit-picking plus laser ablation (PPL). METHODS: All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed. RESULTS: One-hundred and six patients were included, with a median age of 16 years (IQR 15-16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002). Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03). CONCLUSIONS: MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.

[Differences between Patients Undergoing Laparoscopic Cholecystectomy with Discharge at the End of the Day Versus Overnight Stay: A Retrospective Study]. / Diferenças entre os Doentes Submetidos a Colecistectomia Laparoscópica com Alta ao Final do Dia Versus Pernoita: Um Estudo Retrospectivo.

INTRODUCTION: Although laparoscopic cholecystectomy is an increasingly performed technique in the outpatient setting, it is not done in some Units due to lack of overnight stay. The objectives of this study are to identify the differences between patients with discharge at the end of the day versus overnight stay and the factors predicting overnight stay. MATERIAL AND METHODS: A retrospective analysis of the pre, peri and postoperative data of patients operated between January/2014 and December/2017 was performed, and a statistical analysis of the variables. RESULTS: A total of 311 patients were included, 33.4% of whom stayed overnight. Of these, 81.7% were operated after 2pm. As predictors factors of overnight stay, the age (p = 0.001) was identified in the morning group, with a greater possibility of overnight stay (15.3%) from 61.50 years (Younden index = 0.396) and the surgery start time (p < 0.0001) in the afternoon group, with a greater possibility of overnight stay (77.1%) from 4:30 pm (Younden index = 0.492). DISCUSSION: Most patients stayed overnight due to the time at which recovery was completed, since no cause was identified (84.7%). If our unit would not have an overnight stay we would have an overall hospitalization rate of 8.4%, which corresponds to patients with an identified cause for overnight stay, and to admitted patients. CONCLUSION: Ambulatory cholecystectomy can be performed in units that cannot cater for an overnight stay, provided that surgeries are performed during the morning period, patients are carefully selected and there is the possibility of admission.

Introdução: Apesar da colecistectomia laparoscópica ser uma técnica cada vez mais realizada em regime de ambulatório, não é praticada em algumas unidades por ausência de pernoita. São objetivos deste estudo identificar as diferenças entre os doentes com alta ao final do dia versus pernoita e os fatores preditores de pernoita.Material e Métodos: Realizámos uma análise retrospetiva dos dados pré, peri e pós-operatório dos doentes operados entre janeiro de 2014 e dezembro de 2017, tendo-se procedido à análise estatística das variáveis.Resultados: Foram incluídos 311 doentes, sendo que apenas 33,4% pernoitaram. Destes, 81,7% foram operados depois das 14 horas. Como fatores preditores de pernoita foram identificados a idade (p = 0,001) no grupo da manhã, havendo a partir dos 61,50 anos (Younden index = 0,396) uma maior possibilidade de pernoita (15,3%) e a hora de início da cirurgia (p < 0,0001) no grupo da tarde, sendo que os doentes operados após as 16 horas e trinta minutos (Younden index = 0,492) têm maior possibilidade de pernoita (77,1%).Discussão: Grande parte dos doentes pernoitou devido à hora em que completou o recobro, uma vez que não se identificou uma causa para tal (84,7%). Caso a nossa Unidade não dispusesse de pernoita teríamos uma taxa global de internamento de 8,4%, que corresponde aos doentes com causa identificada para a pernoita e os doentes internados.Conclusão: A colecistectomia em ambulatório pode ser realizada em unidades que não disponham de pernoita, desde que as cirurgias decorram no período da manhã, os doentes sejam selecionados de forma criteriosa e exista a possibilidade de internamento.

Participação em programas de intervenção comunitária e qualidade de vida: resultados de um estudo multicêntrico em Portugal / Participation in community intervention programmes and quality of life: findings from a multicenter study in Portugal

Objetivo: Analisar a qualidade de vida (QV) em indivíduos que participam de programas de intervenção comunitária (PIC) orientados para uma vida ativa e saudável. Método: Estudo transversal multicêntrico com 304 participantes, com 55 anos ou mais de idade, a viver na comunidade em três localidades portuguesas. Metade desses indivíduos (n=152) envolvida em PIC (grupo de intervenção). Esse grupo foi emparelhado segundo sexo e grupo etário com número equivalente de participantes (n=152) que não frequenta PIC (grupo de comparação). As atividades dos PIC foram agrupadas segundo a sua natureza: sociorrecreativas, educativas/aprendizagem ao longo da vida (ALV) e atividade física. Recolheu-se informação usando Questionário de Participação Social, WHOQOL-Bref e Escala de Satisfação com a Vida. Resultados: Os participantes dos PIC tinham média de idade de 71,4 (±5,4) anos, eram predominantemente mulheres (75,0%), casados (65,4%), com escolaridade inferior a cinco anos (71,7%) e rendimento familiar mensal até 750 euros (47,4%). O GI apresentou melhor QV no domínio físico do que o GC ( p<0,03). A atividade física foi a modalidade mais frequentada nos PIC (n=119; 78,3%) em comparação com atividades educativas/ALV (n=46; 30,3%) e sociorrecreativas (n=25; 16,4%). Os praticantes de atividade física em PIC apresentaram melhor QV nos domínios psicológico, relações sociais e ambiente do que os não praticantes ( p<0,05). Conclusão: A participação em PIC está associada à QV pelo que, em linha com o quadro do envelhecimento ativo, se recomenda implementar PIC no âmbito das políticas públicas, promovendo sistematicamente a QV da população. AU

Objective: The present study aimed to analyze quality of life (QoL) in participants of community intervention programs (CIP) focused on healthy aging. Method: A multicenter cross-sectional study was carried out with 304 community-dwelling participants, aged 55 years old or more and living in three locations in Portugal. Half of these individuals (n=152) were involved in a CIP (intervention group). The intervention group was paired according to sex and age group with an equivalent number of participants (n=152) that did not take part in a CIP (comparison group). Activities implemented in the CIP were grouped according to their nature: socio-recreational, educational/lifelong learning and physical activity. Data collection involved a Social Participation Questionnaire, the WHOQOL-Bref and the Satisfaction With Life Scale. Results: The CIP participants (n=152) had a mean age of 71.4 years (±5.4), were predominantly women (75.0%), married (65.4%), with fewer than five years of education (71.7%) and a monthly family income of up to 750 euros (47.4%). The intervention group had a significantly higher QoL in the physical domain than the comparison group ( p<0.03). Physical activity was the most frequently attended session in the CIP (n=119, 78.3%), in comparison with educational/ lifelong learning (n=46, 30.3%) and socio-recreational (n=25, 16.4%) activities. People practicing physical activity in the CIP had a significantly higher QoL in the psychological, social relationships and environment domains ( p<0.05). Conclusion: Participation in the CIP was associated with QoL. Therefore, in line with the active aging framework, CIPs must be a part of public policy measures aimed at the QoL of the population.AU