Losartan modifies mesh integration after abdominal wall repair: an experimental study.

PURPOSE: Angiotensin II (AT II) receptor blockers have previously shown to reduce inflammatory response in many settings. We aimed to assess the effects of ATII receptor blocker (Losartan) on mesh integration after abdominal wall repair in a rat model. METHODS: A total of 16 Wistar-Kyoto (WKY) and 16 previously hypertensive (SHRSP) rats were isolated. An acute ventral hernia followed by a bridged repair with heavyweight polypropylene mesh was performed. Subjects received either normal saline (WKY-C n = 8 and SHRPS-C n = 8) or 40 mg/kg losartan (WKY-L n = 8) and SHRPS-L n = 8) in the postoperative period. Blood pressure was recorded preoperatively and weekly after surgery. Necropsy with en-bloc resection of the abdominal wall was performed at postoperative day 30. Macroscopic and microscopic evaluations of the specimens were conducted. H&E and Masson's trichrome were used for histologic evaluation. RESULTS: Both groups receiving Losartan showed a significant reduction of blood pressure after surgery (WKY-L: 130/85 vs 116/81 mmHg, SHRPS-L: 176/137 vs 122/101 mmHg, p < 0.01). A significant reduction in mesh incorporation and adherence scores were also observed on macroscopic analysis in Losartan groups (p < 0.01 and p = 0.02, respectively). Microscopically, higher immature fibroplasia was observed after Losartan, with a significant reduction in scar plate formation and inflammatory response on the prosthetic surface (p = 0.04 and p = 0.02, respectively). CONCLUSION: Losartan modifies the interaction between the host tissue and the prosthesis. An impairment in mesh integration and immature fibroplasia in both normotensive and hypertensive rats detected in our model warrants further research.

Long-term outcomes and quality of life assessment after posterior component separation with transversus abdominis muscle release (TAR).

BACKGROUND: Although transversus abdominis release (TAR) to treat large incisional hernias has shown favorable postoperative outcomes, devastating complications may occur when it is used in suboptimal conditions. We aimed to evaluate postoperative outcomes and long-term follow-up after TAR for large incisional hernias. METHODS: A consecutive series of patients undergoing TAR for complex incisional hernias between 2014 and 2019 with a minimum of 6 month follow-up was included. Demographics, operative and postoperative variables were analyzed. Postoperative imaging (CT-scan) was also evaluated to detect occult recurrences. The HerQLes survey for quality of life (QoL) assessment was performed preoperatively and 6 months after the surgery. RESULTS: A total of 50 TAR repairs were performed. Mean age was 65 (35-83) years, BMI was 28.5 ± 3.4 kg/m2, and 8 (16%) patients had diabetes. Mean Tanaka index was 14.2 ± 8.5. Mean defect area was 420 (100-720) cm2, average defect width was 19 ± 6.2 cm, and mesh area was 900 (500-1050) cm2; 78% were clean procedures, and in 60% a panniculectomy was associated. Operative time was 252 (162-438) minutes, and hospital stay was 4.5 (2-16) days. Thirty-day morbidity was 24% (12 patients), and 16% (8 patients) had surgical site infections. Overall recurrence rate was 4% (2 patients) after 28.2 ± 20.1 months of follow-up. QoL showed a significant improvement after surgery (p = 0.001). CONCLUSIONS: The TAR technique is an effective treatment modality for large incisional hernias, showing an acceptable postoperative morbidity, a significant improvement in QoL, and low recurrence rates at long-term follow-up.

Physiopathological mechanisms of diaphragmatic dysfunction associated with mechanical ventilation. / Mecanismos fisiopatológicos de la disfunción diafragmática asociada a ventilación mecánica.

Ventilator-induced diaphragm dysfunction (VIDD) is the loss of diaphragmatic muscle strength'related to of mechanical ventilation, noticed during the first day or 48hours after initiating controlled mechanical ventilation. This alteration has been related to disruption on the insulin growth factor/phosphoinositol 3-kinase/kinase B protein pathway (IGF/PI3K/AKT), in addition to an overexpression of FOXO, expression of NF-kB signaling, increase function of muscular ubiquitin ligase and activation of caspasa-3. VIDD has a negative impact on quality of life, duration of mechanical ventilation, and hospitalization stance and cost. More studies are necessary to understated the process and impact of VIDD. This is a narrative review of non-systematic literature, aiming to explain the molecular pathways involved in VIDD.

Could long-term follow-up modify the outcomes after laparoscopic TAPP? A 5-year retrospective cohort study.

PURPOSE: Laparoscopic inguinal hernia repair (LIHR) has demonstrated multiple benefits. However, long-term results regarding recurrence and quality of life (QoL) are still on debate. We aimed to analyze postoperative outcomes with long-term follow-up after LIHR. METHODS: A consecutive series from December 2012 to May 2017 of laparoscopic TAPP was included. A minimum of 6 months of follow-up was required for inclusion. The sample was divided into two groups, G1: patients with recurrence and G2: patients without recurrence. Patient's characteristics, operative variables and postoperative outcomes were analyzed. A QoL survey (Eura-HS QoL) was performed in the pre- and postoperative period. RESULTS: A total of 717 laparoscopic TAPP were performed in 443 patients. On univariate analysis, smoking, previous recurrence, mesh size smaller than 12 × 15 cm and surgical teams with less than 30 cases/year showed an increased recurrence rate (p < 0.05). But only smoking and less experienced teams were statistically significant on multivariate analysis (p < 0.01). After a 2-year follow-up, recurrence rate was 1.5%, while it increased to 2.6% (n = 19) at 5-year follow-up. Sixty percent of patients answered QoL survey. Average preoperative scores of pain, activities restriction and aesthetic dissatisfaction improved significantly after 6 months of follow-up in patients without recurrence. CONCLUSIONS: After LIHR, quality of life shows a significant improvement in all parameters. Extending follow-up beyond 2 years after laparoscopic TAPP allows a more accurate assessment of recurrence rate. Smoking and inexperienced teams were significant risk factors for its development.

Psychometric properties of the Aggression Questionnaire: A replication in a sample of partner-assaultive men in psychological treatment.

BACKGROUND: The Aggression Questionnaire (Buss & Perry, 1992) is one of the most widely used validated self-report measures to assess aggression. This study analyzes the factorial structure, internal consistency, and convergent validity of the AQ in a Spanish sample with high levels of violence. METHOD: The questionnaire was administered to 767 partner-assaultive men undergoing psychological treatment. RESULTS: The results of the confirmatory factor analysis supported the four-factor structure. Also, positive correlations between the AQ and other instruments measuring aggression were found, finding that aggression and anger decrease with age in this sample. CONCLUSIONS: The results obtained showed that the AQ is a suitable instrument to assess aggression, anger, and hostility in partner-assaultive men.

Laparoscopic Appendectomy: Risk Factors for Postoperative Intraabdominal Abscess.

BACKGROUND: Laparoscopic appendectomy (LA) has obtained wide acceptance over the last two decades. However, some studies suggest that there is an increased rate of intraabdominal abscess (IAA) when is compared with open appendectomy. Since postoperative IAA is associated with high morbidity, identifying predictive factors of this complication may help to prevent it. The aim of this study was to identify preoperative and intraoperative risk factors for IAA after LA. METHODS: From January 2005 to June 2015, all charts of consecutive patients underwent to LA were revised. Demographics, clinical and intraoperative variables were analyzed. Independent risk factors for postoperative IAA were determined by logistic regression analysis. RESULTS: A total of 1300 LA were performed. The mean age was 34.7 (14-94) years. Two hundred and twenty-five patients (17.3%) had complicated appendicitis with perforation and peritonitis. The conversion rate was 2.3% (30 cases). The average hospital stay was 1.6 (0-27) days. There were 30 (2.3%) postoperative IAA. In the multivariate analysis, body mass index (BMI) >30 (p 0.01), leukocytosis >20,000/mm3 (p 0.02), perforated appendicitis (p < 0.001) and operative time >90 min (p 0.04) were associated with the development of postoperative IAA. There was no mortality in the series. CONCLUSION: Patients with obesity, leukocytosis >20,000/mm3, perforated appendicitis and surgical time longer than 90 min have a higher chance of having a postoperative IAA. A close postoperative follow-up would be necessary in these situations in order to prevent and identify IAA after LA.

Immuno-like assays and biomimetic microchips.

Biomimetic assays with molecularly imprinted polymers (MIPs) are bound to be an alternative to the traditional immuno-analytical methods based on antibodies. This is due to the unique combination of advantages displayed by the artificial materials including the absence of animal inoculation and sacrifice, unnecessary hapten conjugation to a carrier protein for stimulated production, the possibility of manufacturing MIPs against toxic substances, excellent physicochemical stability, reusability, ease of storage, and recognition in organic media. If the selectivity and affinity of MIPs are increased, many more immuno-like assays will be developed using radioactive, enzymatic, colorimetric, fluorescent, chemiluminescent, or electrochemical interrogation methods. This chapter provides a comprehensive comparison between the bio- and biomimetic entities and their usage.

[An outbreak of Salmonella gastroenteritis among hospital workers]. / Brote por Salmonella enteritidis en trabajadores de un hospital.

OBJECTIVE: To describe and identify the causes of an outbreak of Salmonella enteritidis gastroenteritis that took place in June 1998, among tertiary care hospital workers, in Mexico City. MATERIAL AND METHODS: Cases were hospital workers who developed diarrhea or fever associated with gastrointestinal symptoms, after a meal at the hospital's dining room on June eight; controls were asymptomatic employees who also ate at the hospital's dining room on the same day. A food questionnaire was applied, and stool samples were obtained from all study subjects, including kitchen personnel. Blood cultures were practiced for febrile patients. Odds ratios with 95% confidence intervals (95% CI) and the chi-squared were used for statistical analysis. Statistical significance was set at p < 0.05. RESULTS: One-hundred-fifty-five workers developed symptoms, but only 129 (83.2%) answered the questionnaire; 150 controls were also studied. The most common symptoms were diarrhea (85%), abdominal pain (84%), cephalea (81.4%), nausea (78.3%), and chills (74.4%). Eight blood cultures were negative; 59 stool cultures (46%) from cases and six (4%) from controls, were positive for Salmonella enteritidis. Egg-covered meat was the suspected source of infection (OR 19.39, 95% CI 9.09-41.4); some other foodstuffs like fruit dessert and yogurt, were significantly more frequent in cases than in controls. Food cultures were all negative. CONCLUSION: This outbreak was probably caused by Salmonella-contaminated foodstuffs (egg-covered meat with potatoes) due to deficient cooking. This report shows the importance of food-quality programs for hospital meals.

Pediatric emergency medicine. The history of a growing discipline.

Pediatric emergency medicine is evolving into a more clearly described area of medical care. The historical development and future challenges of this subspecialty are discussed. In addition, emergency care for children is reviewed closely, citing differences in the pediatric populations seen in pediatric emergency departments and general emergency departments.

[Changes in hemoglobin in patients with hemolytic anemia]. / Alteraciones de la hemoglobina en pacientes con anemia hemolítica.

Hb alterations studied throughout 2 years in 129 patients are reported, these patients had hemolytic anemia or the possibility of a hemoglobinopathy : 5 were heterozygotes to thalassemia b; 3 were compound-heterozygote of thalassemia a1 and thalassemia a2; 2 for thalassemia b and 2 for thalassemia b and Hb S; 2 homozygotes and 2 heterozygotes for Hb S; 2 was bearing unstable Hb and the other had Hereditary Persistence of Hb F. These results allow the conclusion that thalassemia is the Hb alteration which most frequently causes hemolytic anemia in our population and underscores the importance of the study of these pathologies in selected populations.