Morphological Assessment of the Anterior Loop in the Region of Mental Foramen Using Cone Beam Computed Tomography / Evaluación Morfológica del Asa Anterior en la Región del Foramen Mentoniano Mediante Tomografía Computarizada de Haz Cónico

SUMMARY: Anterior loop in the mental foramen region is a critical region in the mandible. The non detection of anterior loop leads to inadvertent complications during the surgical procedures in this region. This study aimed to evaluate the morphological assessment of the mental foramen's anterior loop (AL) using (CBCT) cone-beam computed tomography. CBCT data was retrieved from January 2018 to December 2022 and screened for eligibility. Images were viewed using panoramic reconstructed views for initial screening. Further multiplanar reformatted view in axial, coronal and sagittal planes were examined. When anterior loop was detected, the path of inferior alveolar canal was traced and the anterior loop was analyzed. Statistical analysis was carried out on the data. Cross-tabulation was done to associate gender and age with the achieved findings (heights and diameters) using the Chi-square test. In this analysis 519 cases were included and examined for presence of anterior loop. 22 cases were included in the study, out of which 10(45.5%) males and 12(54.5%) females. The prevalence of AL is high among females. AL was found higher on the right side in 14 (68.2%) cases compared to the left side with 7 (31.8%) cases. The mean diameter of AL on the right side was 2.5 mm, and on the left side diameter was 1.96 mm. The prevalence of anterior loop in the region of mental foramen in Saudi Population was found to be 4.24%. Careful evaluation for the anterior loop can prevent hemorrhagic episodes during surgical intervention or implant procedures in the mandibular premolar region.

El asa anterior en la región del foramen mentoniano es una región crítica en la mandíbula. La no detección del asa anterior conduce a complicaciones inadvertidas durante los procedimientos quirúrgicos en esta región. Este estudio tuvo como objetivo evaluar la evaluación morfológica del asa anterior (AL) del foramen mental mediante tomografía computarizada de haz cónico (CBCT). Los datos CBCT se recuperaron desde enero de 2018 hasta diciembre de 2022 y se examinaron para determinar su elegibilidad. Las imágenes se visualizaron utilizando vistas panorámicas reconstruidas para la evaluación inicial. Se examinaron además, vistas reformateadas multiplanares en los planos axial, coronal y sagital. Cuando se detectó el asa anterior, se trazó el trayecto del canal mandibular y se analizó el asa anterior. Se realizó un análisis estadístico de los datos. Mediante la prueba de Chi-cuadrado se realizó una tabulación cruzada para asociar el sexo y la edad con los hallazgos obtenidos (alturas y diámetros). En este análisis se incluyeron y examinaron 519 casos para detectar la presencia de asa anterior. Se incluyeron en el estudio 22 casos, de los cuales 10 (45,5 %) eran hombres y 12 (54,5 %) mujeres. La prevalencia de AL es alta entre las mujeres. Se observó que AL fue mayor en el lado derecho en 14 (68,2 %) de los casos en comparación con el lado izquierdo con 7 (31,8 %) casos. El diámetro medio de AL en el lado derecho fue de 2,5 mm y en el lado izquierdo fue de 1,96 mm. La prevalencia del asa anterior en la región del foramen mental en la población saudí fue de 4,24 %. Una evaluación rigurosa del asa anterior puede prevenir episodios hemorrágicos durante una intervención quirúrgica o procedimientos de implante en la región de los premolares mandibulares.

Resección fría sin clips / Cold resection with no clip placement

Cold resection of colonic polyps is an important tool that reduces the incidence of colon cancer. Cold loop polypectomy is a safe and effective technique in colonic lesions smaller than 10 mm and cold mucosectomy with submucosal injection is a growing technique for the resection of non-pedunculated lesions between 10 and 19 mm. Post polypectomy bleeding is an infrequent complication in cold resection, but its recognition is key to reduce the impact of its consequences. The use of hemostatic clips is one of the methods preferred by endoscopists for the management of immediate post polypectomy bleeding, however its usefulness in the prevention of late bleeding is uncertain. In recent years, both meta-analysis and cost- effectiveness studies have concluded that the use of hemoclips does not reduce the incidence of late post-polypectomy bleeding, so their use should be reserved only for high-risk patients.

La resección fría de pólipos colónicos es una importante herramienta que reduce la incidencia de cáncer de colon. La polipectomía con asa fría es una técnica segura y efectiva en lesiones colónicas menores de 10 mm y la mucosectomía fría con inyección submucosa es una técnica en auge para la resección de lesiones no pediculadas entre 10 a 19 mm. El sangrado pospolipectomía es una complicación infrecuente en la resección fría, pero su reconocimiento es clave para disminuir el impacto de sus consecuencias. El uso de clips hemostáticos es uno de los método preferidos por los endoscopistas para el manejo del sangrado inmediato pospolipectomía, no obstante su utilidad en la prevención del sangrado tardío es incierto. En los últimos años, tanto metaanálisis como estudios de costo efectividad concluyen que el uso de hemoclips no reduce la incidencia de sangrado tardío pospolipectomía por lo que su uso debería reservarse sólo a pacientes de alto riesgo.

Early vs. Standard Loop Ileostomy Closure: An Unmatched Case-Control Study / Cierre Temprano vs Estándar de Ileostomía en Asa. Estudio de Casos y Controles no Emparejado

SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.

El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.

Pharmacological Therapy in Inflammatory Bowel Diseases: A Narrative Review of the Past 90 Years.

Inflammatory Bowel Diseases had their first peak in incidence in countries in North America, Europe, and Oceania and are currently experiencing a new acceleration in incidence, especially in Latin America and Asia. Despite technological advances, 90 years after the development of the first molecule for the treatment of IBD, we still do not have drugs that promote disease remission in a generalized way. We carried out a narrative review on therapeutic advances in the treatment of IBD, the mechanisms of action, and the challenges facing the therapeutic goals in the treatment of IBD. Salicylates are still used in the treatment of Ulcerative Colitis. Corticosteroids have an indication restricted to the period of therapeutic induction due to frequent adverse events, while technologies with less systemic action have been developed. Most immunomodulators showed a late onset of action, requiring a differentiated initial strategy to control the disease. New therapeutic perspectives emerged with biological therapy, initially with anti-TNF, followed by anti-integrins and anti-interleukins. Despite the different mechanisms of action, there are similarities between the general rates of effectiveness. These similar results were also evidenced in JAK inhibitors and S1p modulators, the last therapeutic classes approved for the treatment of IBD.

Clinical data or scoring system for predicting mortality in elderly patients with hip fracture: A prospective study.

INTRODUCTION: Hip fracture in elderly individuals is frequent and is related to a high rate of mortality. Finding the best predictor of death will help to develop better patient care. Aim - To analyze the reliability of the clinical data and assessment scores to predict mortality in acute hip fracture in elderly patients. PATIENT AND METHODS: Prospective data were collected from all patients > 65 years with acute hip fracture from May to October 2020. The clinical data collected were age, sex, comorbidities, medication, type of fracture and presence of delirium. The assessment scores were ASA, Lee, ACP and Charlson. RESULTS: The statistically significant results were age > 80 years (OR 1.121 IC95% [1.028-1.221] p = 0.0101) and number of medications (OR5.991 95% CI [2.422-14.823] p <0.001). Three scores showed a correlation with mortality: ASA score (p = 0.017), Lee score (p = 0.024) and ACP score (p = 0.013). The Charlson Comorbidity Index did not correlate with mortality (p = 0.172). CONCLUSION: To stratify the risk of death, both clinical data and scores should be used. The best clinical indicators are age and number of medications, and the scores are ASA, Lee and ACP.

Prevalencia y análisis de factores de infección de sitio quirúrgico en clínica de heridas / Prevalence and Analysis of Surgical Site Infection Factors in Wound Clinic

Introducción: La infección de herida quirúrgica causa altas tasas de morbilidad y repercute sobre los índices de mortalidad. Constituye la primera infección intrahospitalaria entre pacientes quirúrgicos del total de infecciones nosocomiales y la primera entre los pacientes quirúrgicos. Existen factores de riesgo como la clasificación ASA, la diabetes mellitus, la hipertensión arterial y los días de estancia hospitalaria, los cuales influyen en su desarrollo. Objetivo: Determinar la prevalencia de infecciones de sitio quirúrgico por cirugías realizadas en el Hospital Dr. Carlos Canseco de Tampico, ciudad del estado mexicano de Tamaulipas. Métodos: Diseño observacional, analítico, transversal y retrospectivo de 54 pacientes con diagnóstico de infección de sitio quirúrgico. Las variables de estudio se clasificaron como dependientes (género, edad, lugar de origen, días de estancia hospitalaria, peso, índice de masa corporal) e independientes (diagnóstico, procedimiento quirúrgico realizado y clasificación ASA otorgada). Resultados: La población de 40 a 50 años fue la más afectada, con mayor predominancia sobre el género femenino. La Clasificación ASA II y III presentaron mayor prevalencia de infección de sitio quirúrgico, sobre todo en cirugías electivas (28 por ciento). Mientras mayor fue la estancia hospitalaria, mayor fue la probabilidad de desarrollar infección de sitio quirúrgico. Conclusiones: La prevalencia de infección en el sitio quirúrgico en pacientes operados por los distintos servicios quirúrgicos no es similar a la reportada por otros autores. La Clasificación ASA II y III presentaron infección del sitio quirúrgico con más frecuencia, mientras que la comorbilidad más llamativa de este estudio fue el índice de masa corporal como factor de riesgo que no debe pasar desapercibido(AU)

Introduction: Surgical wound infection causes high morbidity rates and impacts mortality rates. It is the first in-hospital infection among surgical patients of all nosocomial infections and the first among surgical patients. There are risk factors that influence its development, such as the ASA classification, diabetes mellitus, arterial hypertension and days of hospital stay. Objective: To determine the prevalence of surgical site infections from surgeries performed at Hospital Dr. Carlos Canseco, of Tampico, a city in the Mexican state of Tamaulipas. Methods: An observational, analytical, cross-sectional and retrospective study was carried out with 54 patients with a diagnosis of surgical site infection. The study variables were classified as dependent variables (gender, age, place of origin, days of hospital stay, weight and body mass index) and independent variables (diagnosis, surgical procedure performed, and given ASA classification). Results: The population aged 40 to 50 years was the most affected, with a greater predominance of the female gender. ASA classification II and III had a higher prevalence of surgical site infection, above all in elective surgeries (28 %). The longer the hospital stay, the higher the probability of developing surgical site infection. Conclusions: The prevalence of surgical site infection in patients operated on by the different surgical services is not similar to that reported by other authors. ASA Classification II and III presented surgical site infection more frequently, while the most remarkable comorbidity in this study was body mass index as a risk factor that should not go unnoticed(AU)

Polymeric Systems for Colon-specific Mesalazine Delivery in the Intestinal Bowel Diseases Management.

The anti-inflammatory 5-aminosalicylic acid (5-ASA) is the main therapeutic option used to prevent and treat inflammatory bowel diseases. The upper intestinal tract performs rapid and almost complete absorption of this drug when administered orally, making local therapeutic levels of the molecule in the inflamed colonic mucosa difficult to achieve. Micro and nanoparticle systems are promising for 5-ASA incorporation because the reduced dimensions of these structures can improve the drug's pharmacodynamics and contribute to more efficient and localized therapy. Together, the association of these systems with polymers will allow the release of 5-ASA through specific targeting mechanisms to the colon, as demonstrated in the mesalazine modified-release dosage form. This review will summarize and discuss the challenges for the oral administration of 5-ASA and the different colon-specific delivery strategies using polymers.

Nanoparticles Obtained from Zein for Encapsulation of Mesalazine.

We encapsulated MSZ in zein nanoparticles (NP-ZN) using a desolvation method followed by drying in a mini spray dryer. These nanoparticles exhibited a size of 266.6 ± 52 nm, IPD of 0.14 ± 1.1 and zeta potential of -36.4 ± 1.5 mV, suggesting colloidal stability. Quantification using HPLC showed a drug-loaded of 43.8 µg/mg. SEM demonstrated a spherical morphology with a size variation from 220 to 400 nm. A FTIR analysis did not show drug spectra in the NPs in relation to the physical mixture, which suggests drug encapsulation without changing its chemical structure. A TGA analysis showed thermal stability up to 300 °C. In vitro release studies demonstrated gastroresistance and a sustained drug release at pH 7.4 (97.67 ± 0.32%) in 120 h. The kinetic model used for the release of MSZ from the NP-ZN in a pH 1.2 medium was the Fickian diffusion, in a pH 6.8 medium it was the Peppas-Sahlin model with the polymeric relaxation mechanism and in a pH 7.4 medium it was the Korsmeyer-Peppas model with the Fickian release mechanism, or "Case I". An in vitro cytotoxicity study in the CT26.WT cell line showed no basal cytotoxicity up to 500 µg/mL. The NP-ZN showed to be a promising vector for the sustained release of MSZ in the colon by oral route.

SASA: una escala sencilla de mortalidad postoperatoria explorada en un centro de atención de tercer nivel en México / SASA: a simple scale of postoperative mortality explored in a third-level care center in Mexico

Resumen: Introducción: Las complicaciones postquirúrgicas han sido causa importante de muerte. Por lo tanto, el uso de predictores sencillos de mortalidad con una nueva escala llamada SASA podría indicar un riesgo postoperatorio de mortalidad a los 30 días aplicado en una muestra en población mexicana. Material y métodos: Exploramos una asociación entre la clasificación de estado físico de la Sociedad Americana de Anestesiólogos (ASA-PS), el Apgar quirúrgico (sAs) y la puntuación de SASA con un análisis univariado en 371 pacientes estimando la relación de probabilidades (OR) y graficando las curvas de operación característica del receptor (receiver-operating-characteristic [ROC]) para cada escala. Resultados: Obtuvimos los valores de dos; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 40.56% (IC del 95%: 35.44-45.83)], 6; [sensibilidad; 81.82% (IC del 95 %: 48.2-97.72), especificidad; 77.5% (IC del 95%: 72.83-81.71)] y 10; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 83.6% (IC del 95%: 78.77-86.78)] como los mejores puntos de corte para el ASA-PS, sAs y SASA respectivamente. Conclusiones: el cálculo de SASA obtuvo la misma sensibilidad, pero mejor especificidad y área bajo la curva cuando se comparó con el ASA-PS y el sAs.

Abstract: Introduction: Post-surgical complications have been a significant cause of death. Therefore, the use of easy preoperative mortality predictors is recommended. A new SASA score could indicate a perioperative risk more globally at 30-days of the postoperative period applied in a Mexican sample. Material and methods: 371 patients were analyzed. We explore an association between the American Society of Anesthesiologists physical status classification (ASA-PS), the surgical Apgar score (sAs), and the new SASA score to assess 30-days mortality after surgery using univariate analysis to estimate the odds ratio (OR). Receiver-operating-characteristic (ROC) curves were plotted for each scale. Results: We obtained values of two; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 40.56% (95% CI: 35.44-45.83)] 6; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 77.5% (95% CI: 72.83-81.71)] and 10; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 83.6% (95% CI: 78.77-86.78)] as the best cut-off points for ASA-PS, sAs and SASA respectively. Conclusions: To predict postoperative 30-days mortality, SASA calculation as a new score obtained the same sensitivity but better specificity and area under the curve (AUC) for the ROC compared with the ASA-PS and the sAs.

Enucleação subconjuntival em um gavião / Subconjuntival enucleation in a Hawk

O gavião-asa-de-telha (Parabuteo unicinctus) é uma ave de rapina que possui ampla distribuição em todo o território nacional. As aves de rapina desenvolveram uma visão tão eficiente que as puseram num patamar diferenciado em relação às outras espécies. No entanto, isso as tornou extremamente sensíveis às afecções oftálmicas, como malformações, inflamações, infecções, degenerações, neoplasias, distúrbios nutricionais e lesões traumáticas. Diante disso, este trabalho apresenta um relato de caso que descreve um gavião-asa-de-telha (Parabuteo unicinctus) adulto, fêmea, pesando 0,800kg, cujo a principal queixa é o olho esquerdo buftálmico e com coloração acinzentada. Este quadro clínico suscitou na remoção do olho pela técnica de enucleação subconjuntival lateral, sendo essa manobra a única forma de interromper o estímulo doloroso e a infecção. Por conseguinte, o trabalho demonstrou a importância e a exequibilidade da técnica correta de enucleação em aves de rapina, de modo a permitir a manutenção da espécie e minimizar os riscos de extinção.

The Harris' hawk (Parabuteo unicinctus) is a bird of prey that has a wide distribution throughout the national territory. Birds of prey have developed such an efficient vision that they are on a different level compared to other species. However, it made them extremely sensitive to ophthalmic conditions, such as malformations, inflammations, infections, degenerations, neoplasms, nutritional disorders, and traumatic injuries. Thus, this work presents a case report that describes an adult female Harris' hawk (Parabuteo unicinctus), weighing 0.800kg, whose main complaint is the left eye buphthalmic and with a grayish color. This clinical condition led to the removal of the eye by the lateral subconjunctival enucleation technique, which was the only way to interrupt the painful stimulus and the infection. Therefore, the work demonstrated the importance and feasibility of the correct technique of enucleation in birds of prey to allow the maintenance of the species and minimize the risks of extinction.

Characteristics, Properties and Analytical/Bioanalytical Methods of 5-Aminosalicylic Acid: A Review.

Five-aminosalicylic acid (5-ASA) is an anti-inflammatory drug indicated in the treatment of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Among the analytical methods of quantification of 5-ASA described in the literature, the High Efficiency Liquid Chromatography stands out, a sensitive technique but with a high cost. In recent years, alternative methods have been developed, presenting efficiency and reduced cost, such as UV/visible spectrophotometric, spectrofluorescent, and electrochemical methods, techniques recommended for the application in quality control and quantification of 5-ASA in pharmaceutical forms and biological fluids. This article aims to review the physicochemical characteristics, pharmacokinetics, mechanisms of action, controlled release systems, and the different analytical and bioanalytical methods for the quantification of 5-ASA.

Clasificación American Society of Anesthesiologisth Physical Status: Revisión de ejemplos locales ­ Chile / Local examples of the American Society of anesthesiologists classification

The American Society of Anesthesiologisth Physical Status (ASA PS) scale is one of the most widely used scales in the world, being an integral part of the pre-anesthetic evaluation of each patient. The purpose of the ASA PS scale is to categorize, and subsequently communicate the patient's risk of undergoing any procedure that requires anesthesia. The objective of this article is to review the classification and incorporate examples, associating them with perioperative risk, in order to improve categorization and clinical practice in our setting.

La escala American Society of Anesthesiologisth Physical Status (ASA PS) es una de las escalas más utilizada en el mundo, siendo parte integral de la evaluación preanestésica de cada paciente. El propósito de la escala ASA PS es categorizar, y posteriormente comunicar el riesgo del paciente de someterse a cualquier procedimiento que requiera anestesia. El objetivo de este artículo es revisar la clasificación e incorporar ejemplos, asociándolos con el riesgo perioperatorio, para así mejorar la categorización y la práctica clínica en nuestro medio.

Cellulose Nanofibers Improve the Performance of Retrograded Starch/Pectin Microparticles for Colon-Specific Delivery of 5-ASA.

Cellulose nanofibers (CNF) were employed as the nanoreinforcement of a retrograded starch/pectin (RS/P) excipient to optimize its colon-specific properties. Although starch retrogradation ranged from 32 to 73%, CNF addition discretely disfavored the RS yield. This result agrees with the finding that in situ CNF reduces the presence of the RS crystallinity pattern. A thermal analysis revealed that the contribution of pectin improves the thermal stability of the RS/CNF mixture. Through a complete factorial design, it was possible to optimize the spray-drying conditions to obtain powders with high yield (57%) and low moisture content (1.2%). The powders observed by Field Emission Gum Scanning Electron Microscopy (FEG-SEM) had 1-10 µm and a circular shape. The developed methodology allowed us to obtain 5-aminosalicilic acid-loaded microparticles with high encapsulation efficiency (16-98%) and drug loading (1.97-26.63%). The presence of CNF in RS/P samples was responsible for decreasing the burst effect of release in simulated gastric and duodenal media, allowing the greatest mass of drug to be targeted to the colon. Considering that spray-drying is a scalable process, widely used by the pharmaceutical industry, the results obtained indicate the potential of these microparticles as raw material for obtaining other dosage forms to deliver 5-ASA to the distal parts of gastrointestinal tract, affected by inflammatory bowel disease.

Disfunción ileostómica en pacientes sometidos a resección anterior baja por un cáncer del recto luego de neoadyuvancia / Ileostomic dysfunction in patients undergoing low anterior resection for rectal cancer after neoadjuvant treatment

Resumen Introducción: La resección anterior baja protegida con una ileostomía en asa (IA) luego de neoadyuvancia es el tratamiento estándar del cáncer del recto bajo localmente avanzado. Objetivos: Investigar la incidencia, características clínicas de la disfunción ileostómica (DI) en estos pacientes y, eventualmente, definir un perfil de riesgo. Materiales y Método: Se analizan 103 pacientes consecutivos. La DI se define como la eliminación por la ileostomía de más de 1,5 litros por día durante 3 o más días consecutivos asociado a distensión y dolor abdominal con intolerancia a la alimentación oral en ausencia de una complicación intraabdominal Clavien-Dindo grado III o mayor. Se comparan el grupo con DI del resto (no DI). Resultados: La DI se presentó en el 14,5% de los casos, se resolvió entre 12 y 70 días (en el 50% superó los 30 días), la tasa de reingreso fue 27% y no hubo reoperaciones en este grupo. No hubo diferencias estadísticamente significativas entre ambos grupos salvo en el tiempo de hospitalizarán y la tasa de reingresos. Discusión: La DI corresponde a un tipo de íleo posoperatorio de gravedad y duración variable que paradojalmente se asocia con la eliminación de altos volúmenes de contenido intestinal por la IA, requiere aporte vigoroso de volumen y electrolitos y en los casos más graves apoyo con nutrición parenteral. El cuadro revierte en plazos variables con manejo conservador. En este estudio no se ha logrado definir un perfil del paciente en riesgo de sufrir esta complicación o factores predictivos de ella.

Background: Diverting loop ileostomy (LI) is commonly performed to protect a distal anastomosis after a low anterior resection. Aim: To investigate the frecuency and clinical features of ileostomic dysfunction (ID) and, eventually, to define a profile of patients at risk of this complicaction. Materials and Method: 103 consecutive patients operated on for rectal cancer were included. ID is defined when the maxime output was more than 1,5 lt/day for three or more consecutive days with biochemical disturbances, associated to abdominal distension and the inability to tolerate oral feeding without postoperative severe complication. Patients with ID were compared with noID group. Results: ID developed in 15 patients, lasting between 12 and 70 days (50% for more then 30 days), the readmission rate was 27% without reoperation in this group. Except for inhospital time and readmission rate, no other difference between both groups were founded. Discussion: ID is a kind of paralitic ileus of variable intensity with paradox high output ileostomy leading to depletion of water and electrolyte imbalance. ID requires reposition of high volumen of fluids and electrolytes and sometimes parenteral nutrition with full recovery in variable periods without invasive treatment. In this study it was not possible to define a patient profile at risk or predictive factores of this complication.

Multi-Dimensional Aesthetic Scan Assessment (MD ASA™): Initial experience with a novel consultation, facial assessment, and treatment planning tool.

BACKGROUND: Comprehensive patient assessment and planning are central to esthetic treatment with injectables. MD ASA™ (Multi-Dimensional Aesthetic Scan Assessment) is a novel tool developed for this purpose. AIMS: To describe the MD ASA technique and present its preliminary application. METHODS: MD ASA breaks down the face into five hierarchies (H1-H5). H1 shifts patients' focus from "distractions" (individual lines and folds) toward the overall messages their face portrays, based on eight Emotional Attributes: four negative (tired, sad, angry, and saggy); four positive (youthful, attractive, contoured, and feminine/masculine). Three priority Emotional Attributes are selected for each patient. This is followed by a process of narrowing down through facial thirds (H2), periorbital and perioral dynamics (H3), facial units (H4), and subunits (H5), to arrive at a final assessment. Based on the key facial signs identified, this can be translated into MD Codes equations and thus a treatment formula. A retrospective analysis was performed based on 12 female patients injected by expert clinicians at an educational event. All patients were selected for, and treated using, a single MD Codes formula derived from a common MD ASA work-up. RESULTS: There were substantial differences between patients and clinicians in their views of which anatomical areas needed treatment-but good alignment on priority Emotional Attributes. Patients were treated only for three negative Emotional Attributes, but improvements were observed across all eight attributes. CONCLUSIONS: MD ASA provides a practical method for translating facial messages into actionable injectable treatment plans and facilitates greater patient-clinician alignment. Prospective studies are warranted.

Resultados y repercusión clínico-anestésica de los exámenes complementarios preoperatorios en pacientes ASA I para cirugía ambulatoria / Results and clinical-anesthetic repercussion of preoperative complementary tests in Asa-I patients scheduled for ambulatory surgery

Introducción: La selección de exámenes laboratorios preoperatorios (test específicos o exámenes por imágenes) debe hacerse como medida complementaria en el caso de sospecha clínica. La solicitud indiscriminada y de rutina es innecesaria e implica costos adicionales para la institución, además de la posibilidad de resultados falsos positivos, con repercusiones más o menos graves para los pacientes. Objetivo: Destacar los resultados y la repercusión clínico-anestésica de los exámenes complementarios preoperatorios en pacientes ASA I para cirugía ambulatoria que llegan a cirugía ambulatoria en el Hospital General Docente Comandante Pinares del municipio de San Cristóbal, Artemisa durante el año 2017. Método: Se realizó un estudio observacional de tipo descriptivo, de corte transversal en el Hospital General Docente Comandante Pinares del municipio de San Cristóbal, Artemisa, durante el año 2017. El universo se representa por 823 pacientes que se sometieron a cirugía ambulatoria, la muestra fue de 394 pacientes, según criterio de selección no probabilístico, intencional. Resultados: El sexo con mayor predominio en las cirugías fue el femenino 65,98 por ciento, las edades más frecuentes fue de 18-30 años. La cirugía electiva que más se realizó fue la colecistectomía 43,18 por ciento. En cuanto a los exámenes paraclínicos realizados, se detectó una baja incidencia de alteraciones, la complicación perioperatoria detectada fue la crisis hipertensiva 0,50 por ciento. Conclusión: Los resultados de los exámenes complementarios fueron normal en la mayoría de los pacientes, sin repercusiones o cambios en la conducta clínico anestésica. Además, generaron un elevado gasto a la institución de salud(AU)

Introduction: The selection of preoperative laboratory tests (specific tests or imaging tests) should be done, as a complementary measure, in the case of clinical suspicion. Indiscriminate and routine request is unnecessary and implies additional costs for the institution, in addition to the possibility of false positive results, with more or less serious repercussions for patients. Objective: To highlight the results and the clinical-anesthetic repercussion of complementary preoperative examinations in ASA-I patients who arrive for ambulatory surgery at Commandant Pinares General Teaching Hospital in San Cristóbal Municipality, Artemisa Province, during the year 2017. Method: An observational, descriptive, cross-sectional study was carried out at Commandant Pinares General Teaching Hospital in San Cristóbal Municipality, Artemisa Province, during the year 2017. The universe was represented by 823 patients who underwent ambulatory surgery. The sample consisted of 394 patients, following nonprobabilistic, intentional selection criteria. Results: The sex with the highest prevalence of surgeries was the female sex (65.98 percent). The most frequent ages were between 18 and 30 years. The most performed elective surgery was cholecystectomy (43.18 percent). Regarding the paraclinical examinations performed, a low incidence of alterations was detected; the perioperative complication detected was hypertensive crisis (0.50 percent). Conclusion: The results of the complementary examinations were normal in most of the patients, without repercussions or changes in the clinical anesthetic behavior. In addition, they generated high expenses for the health institution(AU)

Aspirin and N-acetylcysteine co-administration markedly inhibit chronic ethanol intake and block relapse binge drinking: Role of neuroinflammation-oxidative stress self-perpetuation.

Chronic alcohol intake leads to neuroinflammation and cell injury, proposed to result in alterations that perpetuate alcohol intake and cued relapse. Studies show that brain oxidative stress is consistently associated with alcohol-induced neuroinflammation, and literature implies that oxidative stress and neuroinflammation perpetuate each other. In line with a self-perpetuating mechanism, it is hypothesized that inhibition of either oxidative stress or neuroinflammation could reduce chronic alcohol intake and relapse. The present study conducted on alcohol-preferring rats shows that chronic ethanol intake was inhibited by 50% to 55% by the oral administration of low doses of either the antioxidant N-acetylcysteine (40 mg/kg/d) or the anti-inflammatory aspirin (ASA; 15 mg/kg/d), while the co-administration of both dugs led to a 70% to 75% (P < .001) inhibition of chronic alcohol intake. Following chronic alcohol intake, a prolonged alcohol deprivation, and subsequent alcohol re-access, relapse drinking resulted in blood alcohol levels of 95 to 100 mg/dL in 60 minutes, which were reduced by 60% by either N-acetylcysteine or aspirin and by 85% by the co-administration of both drugs (blood alcohol: 10 to 15 mg/dL; P < .001). Alcohol intake either on the chronic phase or following deprivation and re-access led to a 50% reduction of cortical glutamate transporter GLT-1 levels, while aspirin administration fully returned GLT-1 to normal levels. N-acetylcysteine administration did not alter GLT-1 levels, while N-acetylcysteine may activate the cystine/glutamate transport xCT, presynaptically inhibiting relapse. Overall, the study suggests that a neuroinflammation/oxidative stress self-perpetuation cycle maintains chronic alcohol intake and relapse drinking. The co-administration of anti-inflammatory and antioxidant agents may have translational value in alcohol-use disorders.

Effect of LTRA in L-ASA Challenge for Aspirin-Exacerbated Respiratory Disease Diagnosis.

BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) consists of asthma, chronic rhinosinusitis with polyps, and hypersensitivity to aspirin and/or nonsteroidal anti-inflammatory drugs (NSAIDs). Nasal Lysine Aspirin Challenge is an effective tool for the diagnosis of hypersensitivity to aspirin and/or NSAIDs in patients with AERD. However, there is no unified international consensus version to perform nasal provocation tests (NPTs). OBJECTIVE: To investigate the effect of a leukotriene receptor antagonist (LTRA), montelukast, on the lysine-acetylsalicylate (L-ASA) nasal challenge. METHODS: We included 86 patients divided into 3 samples: group A (AERD without LTRA), group B (AERD with LTRA), and the control group (NSAID-tolerant asthmatics). NPT with L-ASA was performed with 25 mg of L-ASA every 30 minutes 4 times followed by rhinomanometry and spirometric measurements and evaluation of symptoms using a novel clinical scale. RESULTS: In group A, 94.5% of patients (35 of 37) developed a positive response to NPT (drop >40% in total nasal flow), whereas only 46% of group B subjects (13 of 28) showed a positive response to the nasal challenge (P < .001). Control subjects did not show any response to the L-ASA challenge. A novel clinical score demonstrated accuracy in classifying the hypersensitivity to aspirin and/or NSAIDs when patients avoid LTRA (33 of 37). CONCLUSION: Patients with AERD without LTRA showed a greater positive response to the L-ASA challenge than those taking this drug; therefore, LTRA treatment should be discontinued before the challenge for optimal diagnostic accuracy.

Adherence to American Heart Association/American Stroke Association Clinical Performance Measures in a Peruvian Neurological Reference Institute.

BACKGROUND: Little is known about adherence to American Heart Association/American Stroke Association (AHA/ASA) stroke performance measures in developing countries like Peru. AIMS: We assessed adherence and determined factors associated with adherence to the AHA/ASA stroke performance measures at a reference center for neurological diseases in Lima, Peru. METHODS: We conducted a retrospective chart review of 150 stroke patients admitted to the Neurological Institute of Neurological Science from 2014 to 2016 to ascertain adherence to 15 different AHA/ASA stroke performance measures. Adherence was measured as a simple proportion, with both single and composite measures. Associations were analyzed with nonparametric statistics and multivariate logistic regression. RESULTS: Mean adherence to AHA/ASA stroke performance measures was 47%. We observed a statistically significant relationship between adherence to ischemic stroke performance measures and being married (OR = 3.78, 95% CI: 1.05-13.55), as well as an inverse relationship with an onset of symptoms of greater than 4.5 h prior to arrival at the hospital compared to those with ≤ 4.5 h (OR = 0.14, 95% CI: 0.02-0.97). Compared to patients with a lower National Institutes of Health Stroke Scale (NIHSS) score (<13), those with a score of ≥13 were less likely to have good adherence (OR = 0.11, 95% CI: 0.04-0.31). CONCLUSIONS: The mean composite measure of adherence to internationally recognized standards of stroke management in our Peruvian institution was below the level needed for an achievement award by AHA/ASA. An intervention targeted toward stroke prevention and training could lead to improved outcomes of stroke patients in Peru.

Riesgo médico en pacientes estomatológicos según la clasificación ASA / Medical risk in dental patients according to the ASA classification

Introducción: Realizar un tratamiento estomatológico sin comprometer el estado sistémico ha motivado varios estudios. Entre ellos está la determinación del riesgo médico de los pacientes que acuden a la consulta estomatológica según la clasificación ASA, de lo cual no existen reportes en Cuba. Objetivo: Identificar los antecedentes médicos y determinar el riesgo médico ASA de los pacientes en la consulta estomatológica. Material y Método: Se aplicó el cuestionario CROMEC (Clasificación de los Factores de Riesgo Odontológico en los pacientes Médicamente Comprometidos) a 30 pacientes que asistieron por primera vez a la consulta estomatológica. Se tuvo en cuenta edad, sexo, antecedentes médicos y medicamentos utilizados y se determinó la clasificación ASA. Resultados: Predominó el grupo poblacional de 60 o más años con 53,3 por ciento y dentro de este grupo el sexo femenino, 60 por ciento. El 63,3 por ciento de los pacientes estudiados poseían antecedentes médicos, con predominio de los hipertensos en un 56,6 por ciento seguido por los pacientes diabéticos con 36,6 por ciento. Los medicamentos más frecuentemente usados fueron los antihipertensivos para un 32 por ciento seguido por los usados para la diabetes mellitus, 20 por ciento. El 43,3 % de los pacientes se incluyeron en la clasificación ASA II. Conclusiones: Más de la mitad de los pacientes estudiados presentaron antecedentes médicos, los más frecuentes fueron la hipertensión arterial y la diabetes mellitus en correspondencia con el mayor uso de los medicamentos antihipertensivos y para la diabetes mellitus. La mayor cantidad de pacientes correspondieron a la clasificación ASA II, enfermedad sistémica leve, lo que indica tratamiento estomatológico con modificaciones(AU)

Introduction: To carry out a dentist treatment without committing the systemic state has been the aim of several of studies. Among them is the determination of the medical risk of patients attending the dental consultation according to ASA classification, which has not been reported in Cuba. Objective: To identify the medical history and to determine the ASA medical risk of patients in the dental consultation. Material and Method: The CROMEC questionnaire was applied to 30 patients that attended for the first time the consultation. Age, sex, medical history and medications were taken into account to finally determine the ASA classification of the patients. Results: The 60 year-old or more group prevailed with 53,3 percent, inside this group the feminine sex with 60 percent. 63,3 percent of the studied patients had medical history, mainly hypertension with 56,6 percent followed by diabetes mellitus with 36,6 percent. The most frequently used medications were the antihypertensive ones with 32 percent followed by those used by diabetics with 20 percent. 43,3 percent of the patients were included in the classification ASA II. Conclusions: More than half of the studied patients presented medical history; being the most frequent arterial hypertension and diabetes mellitus in correspondence with the biggest use of antihypertensive and diabetes mellitus medications. Most of the patients corresponded to the classification ASA II, light systemic illness, indicating dental treatment with modifications(AU)