Robotic-assisted versus laparoscopic incisional hernia repair: a systematic review and meta-analysis.

PURPOSE: This study aimed to perform a systematic review and meta-analysis comparing the efficacy and safety outcomes of robotic-assisted and laparoscopic techniques for incisional hernia repair. METHODS: PubMed, Embase, Scopus, Cochrane databases, and conference abstracts were systematically searched for studies that directly compared robot-assisted versus laparoscopy for incisional hernia repair and reported safety or efficacy outcomes in a follow-up of ≥ 1 month. The primary endpoints of interest were postoperative complications and the length of hospital stay. RESULTS: The search strategy yielded 2104 results, of which four studies met the inclusion criteria. The studies included 1293 patients with incisional hernia repairs, 440 (34%) of whom underwent robot-assisted repair. Study follow-up ranged from 1 to 24 months. There was no significant difference between groups in the incidence of postoperative complications (OR 0.65; 95% CI 0.35-1.21; p = 0.17). The recurrence rate of incisional hernias (OR 0.34; 95% CI 0.05-2.29; p = 0.27) was also similar between robotic and laparoscopic surgeries. Hospital length of stay (MD - 1.05 days; 95% CI - 2.06, - 0.04; p = 0.04) was significantly reduced in the robotic-assisted repair. However, the robot-assisted repair had a significantly longer operative time (MD 69.6 min; 95% CI 59.0-80.1; p < 0.001). CONCLUSION: The robotic approach for incisional hernia repair was associated with a significant difference between the two groups in complications and recurrence rates, a longer operative time than laparoscopic repair, but with a shorter length of stay.

Decreased mortality among patients with catheter-related bloodstream infections at Catalan hospitals (2010-2019).

BACKGROUND: The incidence of catheter-related bloodstream infections (CRBSIs) has fallen over the last decade, especially in intensive care units (ICUs). AIM: To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality. METHODS: A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare-associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical, and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model. FINDINGS: Over the study period, 4795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (hazard ratio (HR): 0.95; 95% confidence interval (CI): 0.92-0.98). The multivariate analysis identified age (HR: 1.03; 95% CI: 1.02-1.04), femoral catheter (1.78; 1.33-2.38), medical ward acquisition (2.07; 1.62-2.65), ICU acquisition (3.45; 2.7-4.41), S. aureus (1.59; 1.27-1.99) and Candida sp. (2.19; 1.64-2.94) as risk factors for mortality, whereas the mortality rate associated with episodes originating in peripheral catheters was significantly lower (0.69; 0.54-0.88). CONCLUSION: Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programmes should focus especially on ICUs and medical wards, where incidence and mortality rates are highest.

Eficacia de una plataforma de telemedicina (Cronex 3.0) en el abordaje de pacientes EPOC con fenotipo agudizador o mixto y frecuentes ingresos hospitalarios: aspectos metodológicos / Efficacy of a telemedicine platform (Cronex 3.0) in approaching patients with exacerbator or mixed-phenotype COPD and frequent hospitalizations: methodological aspects

La prevalencia de EPOC en España es elevada. En el futuro, debido al aumento del tabaquismo y al cambio en la pirámide de edad, se prevé un mayor aumento en la incidencia y en la prevalencia, siendo necesaria la búsqueda de nuevas estrategias y herramientas encaminadas a evitar o disminuir las agudizaciones. En este sentido, un programa de intervención telemática coordinado y dirigido desde el servicio de neumología del hospital a los pacientes con EPOC y fenotipo Agudizador, así como fenotipo mixto con características de reingresadores, podría disminuir los ingresos hospitalarios de estos pacientes y ser asimismo un programa coste-efectivo. El objetivo principal de este artículo fue recoger de forma exhaustiva y ampliada todo lo concerniente al diseño metodológico utilizado en el ensayo clínico denominado CRONEX 3.0 no publicado y que aborda el impacto de la telemedicina en la tasa de reingresos por EPOC y su análisis de coste-efectividad

The prevalence of COPD in Spain is high. In the future, due to the increase in tobacco use and the change in the age pyramid, a greater increase in the incidence and prevalence is expected, making it necessary to find new strategies and tools aimed at avoiding or decreasing exacerbations. In this sense, a coordinated telematic intervention program managed by the pulmonology department at the hospital directed towards patients with exacerbator and mixed-phenotype COPD with characteristics of requiring repeat hospitalizations could decrease hospitalizations in these patients and be a cost-effective program at the same time. The main aim of this article is to comprehensively and broadly include everything not yet published regarding the methodological design used in the clinical trial CRONEX 3.0 and which addresses the impact of telemedicine on the rate of rehospitalizations due to COPD and its cost-effectiveness analysis

Effectiveness of different treatments in obesity hypoventilation syndrome.

Obesity hypoventilation syndrome (OHS) is an undesirable consequence of obesity, defined as daytime hypoventilation, sleep disorder breathing and obesity; during the past few years the prevalence of extreme obesity has markedly increased worldwide consequently increasing the prevalence of OHS. Patients with OHS have a lower quality of life and a higher risk of unfavourable cardiometabolic consequences. Early diagnosis and effective treatment can lead to significant improvement in patient outcomes; therefore, such data has noticeably raised interest in the management and treatment of this sleep disorder. This paper will discuss the findings on the main current treatment modalities OHS will be discussed.

Bemiparin as a long-term treatment for venous thrombosis in cancer patients: the ELEBAMA study.

INTRODUCTION: Low-molecular-weight heparin (LMWH) is the standard treatment for cancer-associated venous thromboembolism (VTE). There have been no specific studies evaluating bemiparin for VTE in people with cancer. The aim of this study is to evaluate the effects of bemiparin for long-term treatment of VTE in routine clinical practice. METHODS/PATIENTS: Prospective observational study. Consecutive patients with active cancer and VTE, under treatment with bemiparin for at least 6 months, were recruited. RESULTS: We included 89 patients. The 6- and 9-month cumulative VTE recurrence rates were 2.4% and 5.9%, respectively. The 6-month cumulative rate of major bleeding was 1.3%, and of clinically relevant non-major bleeding, 8%. CONCLUSIONS: The incidence of events in this study is lower than that reported in randomized trials. Bemiparin is effective and safe for the long-term treatment of cancer-associated VTE in routine clinical practice.

[Pharmacological treatment compliance and a description of its associated factors in patients with myasthenia gravis]. / Adhesion al tratamiento farmacologico y descripcion de sus factores asociados en pacientes con miastenia grave.

INTRODUCTION: Medication adherence is a public health problem and this has not been previously studied in myasthenia gravis patients. AIM: To determine if patients with myasthenia gravis are adherent to treatment and to describe the clinical factors of patients who are non-adherent to treatment. PATIENTS AND METHODS: Cross-sectional study of patients with myasthenia gravis followed at Padre Hurtado Hospital, Santiago de Chile, who received their medication through the hospital and therefore were on the pharmacy's list. Patients' participation was voluntary and anonymous. Medication adherence was assessed with the Morisky-Green-Levine survey (4 items). Patients were assessed for myasthenia gravis severity with the Manual Muscle Test, and myasthenia gravis-related quality of life with the MG-QOL15. Finally, patients were screened for depression with the 12-Item General Health Questionnaire. RESULTS: 26 patients were enrolled and 15 (57.7%) were women. Only 10 (38.5%) of patients were adherent to treatment. Patients who were not adherent to medication had more weakness (p = 0.06), worse quality of life (p = 0.008), were taking a greater number of myasthenia gravis drugs (p = 0.003) and had a higher risk of depression (p = 0.03). CONCLUSIONS: In this cohort of myasthenia gravis patients, three out of five patients were not adherent to treatment. These patients tended to have more weakness, worse quality of life and higher risk of depression. Medication adherence should be assessed routinely in patients with myasthenia gravis.

TITLE: Adhesion al tratamiento farmacologico y descripcion de sus factores asociados en pacientes con miastenia grave.Introduccion. La adhesion al tratamiento farmacologico es un problema de salud publica, pero no se ha estudiado en pacientes con miastenia grave. Objetivo. Determinar la adhesion al tratamiento farmacologico en pacientes con miastenia grave y describir al grupo de pacientes no adherentes al tratamiento. Pacientes y metodos. Estudio de corte transversal, en pacientes con miastenia grave, en control y abandono del tratamiento farmacologico en el Hospital Padre Hurtado, Santiago de Chile. Los pacientes fueron invitados a participar de forma voluntaria y anonima. Se evaluo la adhesion al tratamiento con la escala Morisky-Green-Levine de cuatro items. Ademas, se evaluo la gravedad de la miastenia grave con el test manual de fuerza muscular (MMT); la calidad de vida asociada a la miastenia grave, con el 15-Item Quality Of Life Instrument for Myasthenia Gravis (MG-QOL15), y el riesgo de depresion, con el cuestionario de salud general de 12 items (GHQ-12). Resultados. Participaron 26 pacientes, de los cuales 15 (57,7%) eran mujeres. Solo 10 (38,5%) mostraron adhesion al tratamiento. Los no adherentes presentaron mayor debilidad (MMT; p = 0,06) y peor calidad de vida (MG-QOL15; p = 0,008), y tomaban mas farmacos para la miastenia grave (p = 0,003). Ademas, presentaron mayor riesgo de depresion (GHQ-12; p = 0,03) comparados con el grupo de adhesion al tratamiento. Conclusion. Tres de cada cinco pacientes con miastenia grave abandonaron el tratamiento, lo que se asocio con mayor debilidad, peor calidad de vida y mayor riesgo de depresion. Por lo tanto, deberia evaluarse la adhesion al tratamiento en los pacientes con miastenia grave.

Integrase strand-transfer inhibitor polymorphic and accessory resistance substitutions in patients with acute/recent HIV infection.

OBJECTIVES: The most recent guidelines suggest using integrase strand-transfer inhibitors (InSTIs) as the preferred antiretroviral regimens for naive HIV-infected individuals. However, resistance to InSTIs is not monitored in many centres at baseline. This study aimed to evaluate the prevalence of InSTI resistance substitutions in newly diagnosed patients with acute/recent HIV infection. METHODS: Genotypic drug resistance tests were performed in all consecutive patients prospectively enrolled with a documented infection of <6 months, from 12 May 2015 to 12 May 2016. Sequences were obtained by high-throughput sequencing. RESULTS: Five out of 36 consecutive patients (13.89%, 95% CI = 4.67-29.5) with acute/recent HIV infection were detected to have strains carrying InSTI polymorphisms or substitutions conferring low-level resistance to raltegravir and elvitegravir. Four patients had the 157Q polymorphism and one patient had the Q95K substitution. All cases were MSM patients infected with subtype B strains. Viral loads ranged from 2.92 to 6.95 log10 copies/mL. In all cases, the mutational viral load was high. Three patients initiated dolutegravir-based regimens and became undetectable at first viral load control. There were no major viral or epidemiological differences when compared with patients without InSTI substitutions. CONCLUSIONS: Although signature InSTI substitutions (such as Y143R/C, N155H or Q148K/R/H) were not detected, polymorphisms and substitutions conferring low-level resistance to raltegravir and elvitegravir were frequently found in a baseline genotypic test. All cases were infected with subtype B, the most frequent in Europe. In the context of primary HIV infection, virological response should be carefully monitored to evaluate the impact of these InSTI polymorphisms and substitutions.

Peripheral Arterial Disease Incidence and Associated Risk Factors in a Mediterranean Population-based Cohort. The REGICOR Study.

OBJECTIVES: The reported incidence of lower extremity peripheral arterial disease (PAD) in Western countries ranges between 530 and 2,380 per 100,000 person years. The aims of this study were to determine the incidence of PAD and identify associated risk factors in a Mediterranean population. METHODS: Cardiovascular risk factors, the Edinburgh questionnaire, and ankle brachial index (ABI) were collected from 5,434 individuals, aged 35-79 years, from a population based cohort study at baseline and after a mean of 5.7 years follow up. PAD was defined as ABI <0.9 or a clinical diagnosis during follow up. Logistic and regression tree analyses were used to identify factors associated with PAD. RESULTS: In total, 118 new cases of confirmed PAD were identified. The cumulative population incidence rate of PAD was 377 cases per 100,000 person years. For symptomatic PAD, this figure was 102 per 100,000 person years. The most important risk factors for PAD were current (OR 2.30; 95% CI 1.27-4.16) or former smoking (OR 2.02; 95% CI 1.19-3.43), diabetes (OR 1.78; 95% CI 1.17-2.72), age (OR 1.04; 95% CI 1.02-1.07), history of cardiovascular disease (OR 2.06; 95% CI 1.22-3.51), triglycerides level (OR 1.56; 95% CI 1.07-2.29), and systolic blood pressure (OR 1.02; 95% CI 1.01-1.03). In the population ≤65 years the most relevant risk factor was diabetes, whereas in those >65 years smoking was the leading factor. Long-term uncontrolled diabetes was the strongest risk factor for PAD (OR 10.14; 95% CI 3.57-28.79). CONCLUSION: The incidence of lower extremity PAD is lower in the Mediterranean area than has been reported for other areas. The data suggest that patients with long-term uncontrolled diabetes and former and current smokers older than 65 years should be considered for PAD screening.

Anemia Increases Mortality After Open or Endovascular Treatment in Patients with Critical Limb Ischemia: A Retrospective Analysis.

OBJECTIVES: Pre-operative anemia has been associated with increased post-operative morbidity and mortality in elective cardiac surgery, but its association with post-operative mortality after open or endovascular surgery for critical limb ischemia (CLI) is not well established. The aim of this study was to evaluate the relationship between pre-operative anemia and mortality in surgery for CLI. MATERIALS AND METHODS: A retrospective study of 403 consecutive patients (mean age = 73; 73% male) undergoing open (n = 191, 47%) or endovascular (n = 212, 53%) surgery for CLI between 2005 and 2013 was performed. Neither redo revascularization procedures (ipsilateral or contralateral) nor acute limb ischemia patients were included as new cases. RESULTS: The best cut off (receiver operating characteristic curve) that related pre-operative hemoglobin to mortality was 10 g/dL. The immediate (in hospital or < 30 days) mortality rate was 8% (32 patients), with no significant differences between open and endovascular surgery. Patients with a pre-operative hemoglobin <10 g/dl had a higher immediate mortality rate (17.7% vs. 5.1%), with a risk (OR), adjusted by age and prior myocardial infarction, of 3.9, 95% CI 1.8-8.4 (p = 0.001). The mean follow up of the cohort was 30 months (97% complete). Similarly, a pre-operative hemoglobin <10 g/dL was significantly associated with a lower 1 year (55 vs. 83%) and 5 year survival rate (21 vs. 53%) with an associated risk (HR) of 2.5, 95% CI 1.8-3.4 (p < 0.001) adjusted by age, previous myocardial infarction, chronic renal failure, stroke, diabetes mellitus, and ischemic ulcers. CONCLUSIONS: Pre-operative anemia is a risk factor for immediate and late mortality among patients with CLI, regardless of other risk factors and the type of revascularization technique. Prospective studies are needed to evaluate the potential effect of its treatment on survival outcomes.

Adding low ankle brachial index to classical risk factors improves the prediction of major cardiovascular events. The REGICOR study.

OBJECTIVES: Cardiovascular risk estimation is a key element of current primary prevention strategies, despite its limited accuracy. Several biomarkers are being tested to assess their capacity to improve coronary (CHD) and cardiovascular (CVD) prediction. One of these biomarkers is ankle brachial index (ABI). The aim of this study was to assess whether the inclusion of ABI improved the predictive capacity of the Framingham-REGICOR risk function in an area of low CVD incidence. METHODS: A total of 5248 individuals, aged 35-74 years, from a prospective population-based cohort study were followed up for a median 5.9 years. Baseline ABI was measured using a standardized method. All incident CHD (angina, myocardial infarction, coronary revascularization, CHD death) and CVD (also including fatal and non-fatal stroke) events were recorded. Improvements in discrimination (ΔC-statistics) and reclassification by net reclassification index (NRI) were assessed. RESULTS: During follow-up, 111 and 64 subjects presented with a coronary or cerebrovascular event. Pathological ABI (≤0.9) was associated with increased CHD and CVD risk (HR: 2.08 and HR: 2.24, respectively; p-value<0.001). Including ABI in the Framingham-REGICOR function improved both its discrimination and its reclassification capacity for CVD events but not for CHD events; the ΔC-statistic for CVD events was 0.007 (95% Confidence Interval: 0.001; 0.017) and the NRI was 0.029 (95% CI: 0.014-0.045; p-value<0.001). CONCLUSION: Inclusion of the ABI improves the predictive capacity of the Framingham-REGICOR risk function. The study results indicate the potential value of including this simple test in cardiovascular risk stratification and support current guidelines recommendations.

[Overall long-term survival in lung cancer analyzed in 610 unselected patients]. / Supervivencia global a largo plazo en el cáncer de pulmón. Análisis de una serie de 610 pacientes no seleccionados.

INTRODUCTION AND OBJECTIVES: Many studies of lung cancer survival are carried out in patients selected for certain features that usually influence prognosis favorably. The objective of this study was to assess the overall survival of unselected patients with a diagnosis of lung cancer in our practice. PATIENTS AND METHODS: We studied 610 patients for whom survival information was available, a population comprising 88% of the 694 with lung cancer diagnosed in our hospital from 1991 through 1998. The variables analyzed for their correlation with survival were age, sex, histology, tumor-node-metastasis (TNM) stage, treatment, and time of diagnosis (with patients grouped by 2-year periods). RESULTS: The cases of 596 men and 14 women with a mean age of approximately 67 years were studied. Small cell tumors were found in 141, non-small cell tumors in 447, and other tissue types in 22. Surgical excision was carried out on 118 (19.3%), and treatment was confined to control of symptoms for 6.4% of the patients with small cell tumors and 40.5% of those with non-small cell cancer. Symptomatic treatment alone was more common for patients older than 70 years (52.5%) and less common during the last 2 years of the study period (1997-1998: 19%). Overall 5-year survival was 7.9% (2.8% in small cell cancer and 9.4% in non-small cell cancer). Survival rates were lower in patients over 70 years of age. Significant differences in survival were seen for successive TNM stages, with the exception of IIIA and IIIB. The 1997-1998 period saw better survival rates, at 40.8% after 1 year and 11.2% after 5 years. CONCLUSIONS: The survival rates in lung cancer patients in our hospital practice are low because the rate of surgical resections is low owing to the high percentage of cases found in advanced stages. Our observations are similar to those reported from other European countries.