Late Gadolinium Enhancement by Cardiac Magnetic Resonance and Speckle Tracking Echocardiography in the Evaluation of Cardiac Complications in Chagas Cardiomyopathy: A Systematic Review.

Background: Chagas cardiomyopathy (CC) increases cardiovascular mortality associated with congestive heart failure (CHF), ventricular arrhythmias (VA), and sudden cardiac death (SCD). Different imaging techniques have been tested to assess disease progression and cardiac risk in individuals with Chagas disease (ChD). In this systematic review, we evaluated the accuracy in detecting cardiac complications in CC patients using cardiac magnetic resonance (CMR) and speckle tracking echocardiography (STE). Methods: A search was done on PubMed, Cochrane, and Embase for studies in humans over 18 years of age with ChD. Demographic data, research methodology, imaging parameters, and cardiac outcomes were extracted, and study quality was assessed, resulting in a narrative description. Results: Twelve studies with 1124 patients were analyzed. One study discovered a contractility pattern by STE. Four studies assessed the identification of Early Cardiac Impairment (ECI) and VA risk, respectively, while three studies evaluated the risk of SCD. Global Longitudinal Strain (GLS) identified patients with ECI (-18.5 ± 3.4% non-fibrosis vs -14.0 ± 5.8% fibrosis, p = 0.006 and -18 ± 2% non-fibrosis vs -15 ± 2% fibrosis, p = 0.004). The amount of fibrosis > 11.78% or in two or more contiguous transmural segments were markers for VA risk. GLS and the amount of fibrosis were found to be predictors of SCD. Conclusions: STE may be considered a screening technique for identifying the subclinical status of CHF. CMR using Late Gadolinium Enhancement (LGE) is considered a relevant parameter for stratifying patients with ChD who are at risk of SCD. Fibrosis and GLS can be used as markers to categorize patients at risk for arrhythmias.

Peritoneal carcinomatosis after minimally invasive surgery versus open radical hysterectomy: systematic review and meta-analysis.

OBJECTIVE: To assess the incidence of peritoneal carcinomatosis in patients undergoing minimally invasive or open radical hysterectomy for cervical cancer. METHODS: The MEDLINE (accessed through Ovid), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials, and Scopus databases were searched for articles published from inception up to April 2022. Articles published in English were considered. The included studies reported on patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IIA squamous cell carcinoma, adenocarcinoma, and/or adenosquamous carcinoma of the cervix who underwent primary surgery. Studies had to report at least one case of peritoneal carcinomatosis as a recurrence pattern, and only studies comparing recurrence after minimally invasive surgery versus open surgery were considered. Variables of interest were manually extracted into a standardized electronic database. This study was registered in PROSPERO (CRD42022325068). RESULTS: The initial search identified 518 articles. After the removal of the duplicate entries from the initial search, two authors independently reviewed the titles and abstracts of the remaining 453 articles. Finally, 78 articles were selected for full-text evaluation; 22 articles (a total of 7626 patients) were included in the analysis-one randomized controlled trial and 21 observational retrospective studies. The most common histology was squamous cell carcinoma in 60.9%, and the tumor size was <4 cm in 92.8% of patients. Peritoneal carcinomatosis pattern represented 22.2% of recurrences in the minimally invasive surgery approach versus 8.8% in open surgery, accounting for 15.5% of all recurrences. The meta-analysis of observational studies revealed a statistically significant higher risk of peritoneal carcinomatosis after minimally invasive surgery (OR 1.90, 95% CI 1.32 to 2.74, p<0.05). CONCLUSION: Minimally invasive surgery is associated with a statistically significant higher risk of peritoneal carcinomatosis after radical hysterectomy for cervical cancer compared with open surgery.

Individual and Contextual Factors Associated with Teenage Pregnancy in Colombia: A Multilevel Analysis.

OBJECTIVE: To analyze municipal- and individual-level factors related to the prevalence of teenage pregnancy in Colombia during 2015. METHODS: We analyzed 660,767 births registers, of which 21.5% recorded adolescent women. At an individual level, marital status, educational level, area of residence, and access to health services were included in the analysis. At the contextual level, Colombian municipal socioeconomic characteristics and proxies of violence and poverty were analyzed. A multilevel logistic regression model was generated with a Markov Chain Monte Carlo estimation method using 100,000 simulations in MLwiN 2.32 software. RESULTS: Multilevel modeling revealed an increased risk of teenage pregnancy in municipalities with the highest numbers of people expelled by forced displacement (OR 1.21; CI 95%, 1.13-1.29) and with unsatisfied basic needs (OR 1.09; CI 95%, 1.02-1.17). At an individual level, the majority of the teenage women were unmarried and/or had an unstable partnership, a low level of educational, a subsidized health regimen, and resided in the municipal seat. CONCLUSIONS: Municipal contextual variables related to poverty, violence, and social inequity contribute to an increase in teenage pregnancy in Colombia. At the individual level, marital status, educational level, and area of residence is associated with teenage pregnancy. It is therefore imperative to include municipal contextual characteristics in the design of the national political agenda.

Caracterización y factores de riesgo de caídas en un hospital de alta complejidad de Bogotá (Colombia) / Characteristics and Risk Factors of Patient Falls in a High-Complexity Hospital in Bogotá, Colombia / Caracterização e fatores de risco para quedas em hospital de alta complexidade em Bogotá (Colômbia)

Introducción: las caídas intrahospitalarias están dentro de las prioridades nacionales e internacionales en cuanto a calidad asistencial. Aunque se reconocen elementos intrínsecos y extrínsecos al paciente con la presencia de caídas, en Colombia existe poca evidencia al respecto. El objetivo es caracterizar las caídas de pacientes ocurridas entre 2013 y 2016, y sus factores asociados en un hospital de alta complejidad de Bogotá (Colombia). Materiales y métodos: estudio observacional retrospectivo basado en el registro de caídas que ocurrieron en el periodo de análisis en un hospital de alta complejidad. Se utilizó estadística descriptiva y análisis de regresión logística binaria. Resultados: de 951 caídas que ocurrieron entre 2013 y 2016, el 63.1 % se clasificó como eventos adversos. Según la gravedad, el 54.2 % fue "moderado" y "severo". De la muestra de pacientes, el 53.0 % fue hombres, el 65.5 % tenía 65 o más años (mediana = 71 años; mínimo = 16 años y máximo = 98 años), el 23.2 % tenía alguna enfermedad del sistema circulatorio. Se asoció con un mayor riesgo para una caída que culmina en evento adverso: ser mujer (ic95 %; or= 1.08-1.87), el turno laboral noche (ic95 % = 1.09-2.03) y las especialidades clínicas (ic95 % = 1.36-4.84) y quirúrgicas (ic95 % = 1.14-4.46). Conclusión: las caídas de pacientes son un evento adverso importante de intervenir en las instituciones hospitalarias. Se identificaron elementos intrínsecos, principalmente la edad, y extrínsecos, el turno laboral y la especialidad médica, relacionados con la probabilidad de generar un daño en el paciente ante una caída

Introduction:Intrahospitalary falls are among the national and international priorities in terms of quality of care. Although several intrinsic and extrinsic elements associated with patient falls have been recog-nized, information and evidence on these elements are lacking in Colombia. Thus, we aimed to charac-terize the falls of patients and their associated factors in a high-complexity hospital in Bogotá, Colombia between 2013 and 2016. Materials and methods:A retrospective observational study based on the data obtained from the registry of falls that occurred during the study period in a high-complexity hospital in Bogotá, Colombia was carried out. Descriptive statistical analysis and binary logistic regression analysis were performed. Results:Of the 951 falls that occurred between 2013 and 2016, 63.1% were classified as adverse events. According to the severity of falls, 54.2% falls were "moderate" and "severe." According to the demographic characteristics, 53.0% patients were men, 65.5% were ≥65 years old (median: 71 years, minimum: 16 years, maximum: 98 years), and 23.2% had circulatory diseases. The following factors were found to be associated with an increased risk for a fall that culminated in an adverse event: being a woman (95% ci = 1.08­1.87), night shift (95% ci; or = 1.09­2.03), and clinical (95% ci = 1.36­4.84) and sur-gical specialties (95% ci = 1.14­4.46). Conclusion: Patient falls are important adverse events that require intervention in hospital institutions. Intrinsic elements (mainly age) and extrinsic elements (work shift and medical specialty) were identified to cause harm to the patient in the event of a fall

Introdução: as quedas intra-hospitalares estão entre as prioridades nacionais e internacionais quanto àqualidade do atendimento. Embora sejam reconhecidos elementos intrínsecos e extrínsecos ao paciente com a frequência de quedas, na Colômbia há poucas evidências a esse respeito. O objetivo é caracterizar as quedas de pacientes ocorridas entre 2013 e 2016 e seus fatores associados em um hospital de alta complexidade em Bogotá (Colômbia). Materiais e métodos: estudo observacional retrospectivo baseado no registro das quedas ocorridas no período de análise em um hospital de alta complexidade. Foram utilizadas estatística descritiva e análise de regressão logística binária. Resultados: das 951 quedas ocor-ridas entre 2013 e 2016, 63.1% foram classificadas como eventos adversos. De acordo com a gravidade, 54.2% foram "moderadas" e "graves". Da amostra de pacientes, 53.0% eram homens, 65.5% tinham 65 anos ou mais (mediana = 71 anos; mínimo = 16 anos e máximo = 98 anos), 23.2% apresentavam alguma doença do aparelho circulatório. Foi associado a um maior risco de queda que culmina em um evento adverso: ser mulher (ic 95%; or = 1.08-1.87), turno noturno de trabalho (ic 95% = 1.09-2.03) e as especia-lidades clínica (95% ic = 1.36-4.84) e cirúrgica (ic 95% = 1.14-4.46). Conclusão: as quedas de pacientes são um importante evento adverso para intervenção nas instituições hospitalares. Foram identificados ele-mentos intrínsecos, principalmente a idade, e elementos extrínsecos, turno de trabalho e especialidade médica, relacionados à probabilidade de causar dano ao paciente em caso de queda