Textbook outcome in colon carcinoma: implications for overall survival and disease-free survival.

BACKGROUND: Textbook outcome (TO) is a multidimensional quality management tool that uses a set of traditional surgical measures to reflect an "ideal" surgical result for a particular pathology. The aim of the present study is to record the rate of TO in patients undergoing elective surgery for colon cancer (CC). MATERIAL AND METHODS: Retrospective study of all patients undergoing scheduled CC surgery at a Spanish university hospital from September 2012 to August 2016. Patients with rectal cancer were excluded. The variables included in the definition of TO were: R0 resection, number of isolated nodes ≥ 12, no Clavien-Dindo ≥ IIIa complications, no prolonged stay, no readmissions, and no mortality in the first 30 days. The main objective of this study is to analyse the achievement of TO in these patients and to assess the relationship between TO and overall and disease-free survival. RESULTS: Five hundred and sixty-four patients were included in the study. TO was achieved in 49.8%. The sample had a mean age of 69 ± 11 years, and 60% were male. Female sex (OR 1.61; 95% CI 2.30-1.13), T3 and T4 classification (OR 2.50, 95% CI 4.59-1.36, and OR 2.55, 95% CI 5.21-1.24 respectively) and laparoscopic approach (OR 1.53, 95% CI 2.33-1.00) were independent factors that were significantly associated with achieving a TO. Patients who achieved TO had higher overall survival (p = 0.008) than those who did not. However, with regard to disease-free survival, no statistically significant differences were found (p = 0.303). CONCLUSION: TO is a useful, easy-to-interpret management tool for measuring oncological results and for predicting patient survival.

Comparison of continuous infusion with intermittent bolus administration of cefotaxime on blood and cavity fluid drug concentrations in neonatal foals.

Healthy neonatal foals were treated with cefotaxime by bolus (40 mg/kg i.v. q6h for 12 doses; n=10) or by infusion (loading dose of 40 mg/kg i.v. followed by continuous infusion of a total daily dose of 160 mg/kg per 24 h for 3 days; n=5). Population pharmacokinetics was determined, and concentrations in cavity fluids were measured at steady state (72 h). Highest measured serum drug concentration in the bolus group was 88.09 µg/mL and minimum drug concentration (C(min)) was 0.78 µg/mL at 6-h postadministration (immediately before each next dose), whereas infusion resulted in a steady-state concentration of 16.10 µg/mL in the infusion group. Mean cefotaxime concentration in joint fluid at 72 h was higher (P=0.051) in the infusion group (5.02 µg/mL) compared to the bolus group (0.78 µg/mL). Drug concentration in CSF at 72 h was not different between groups (P=0.243) and was substantially lower than serum concentrations in either group. Insufficient data on pulmonary epithelial lining fluid were available to compare the methods of administration for cefotaxime in this cavity fluid. Results support continuous drug infusion over bolus dosing in the treatment for neonatal foal septicemia to optimize time that cefotaxime concentration exceeds the minimum inhibitory concentration of common equine pathogens.

Flow-controlled ventilation and hi-flow nasal oxygen in laser surgery for a grade III subglottic stenosis patient.

A 49-year old patient (BMI 29.4kg/m2 and ASA III) with grade III subglottic stenosis (> ventilator in flow controlled ventilation mode, which allowed us to regulate both inspiratory and expiratory flow without compromising gas exchange despite maintaining peak FIO2 at 0.3 due to the risk of ignition. Before proceeding with endoscopic dilation, the 4.5mm laser endotracheal tube was withdrawn and high flow nasal cannula oxygenation was started in order to prolong apnoeic oxygenation. Total apnoea time was 11min, maintaining SpO2>70%) underwent laser resection followed by dilation. During resection he was ventilated by the Evone>ventilator; high flow nasal cannula therapy; apnoeic oxygenation-98% and peak EtCO2 60mmHg throughout the procedure.

[Analysis of prescriptions given on discharge from the emergencies department. Economic impact]. / Análisis de la prescripción al alta en urgencias. Impacto económico.

OBJECTIVE: To analyse the characteristics and cost of medical prescriptions given upon discharge from the casualty department, as well as the savings made by making substitutions with generic drugs or other equivalent pharmaceutical products in a third level hospital. METHODS: 669 patients were chosen using a cluster sample with a sub-sample. The following variables were considered: a) analysis of the prescription (medication quantification, active ingredients and most prescribed therapeutic groups, and possibility of prescribing generic drugs); b) calculation of cost and saving estimate (price to public and equivalent products); c) prescription quality (adherence to the guide and percentage of products of high therapeutic use.) RESULTS: 370 of the 669 patients received medication when they were discharged, with an average of 1.7 per patient. 629 products were prescribed, 16 % due to their active ingredient, with 37.53 % generic products available. The main active ingredients prescribed were paracetamol, ibuprofen and omeprazole amounting to 26.70 % of the total prescribed and the therapeutic groups that were highlighted were locomotor apparatus, the nervous system, the digestive apparatus and metabolism with 69.39 % of the total. 92.84 % of the prescriptions adhered to the pharmaco-therapeutic guide and 98.41 % were of high therapeutic use. The annual cost of prescribed medication was 1,013,778 Euro and the saving made by generic product substitution and a programme of therapeutic equivalents was 145,971 Euro. CONCLUSIONS: A prescription based on its active ingredients and a therapeutic and generic substitution produce a significant saving both for the patient and for the hospital.

[Capillary hemoglobin as a predictor of the response to the oral intake of iron in children with iron deficiency]. / La hemoglobina capilar como predictor de la respuesta al hierro oral en niños con deficiencia de hierro.

A study was made to determine the prevalence of anemia in apparently healthy children of both sexes aged 6 to 24 months attending the preventive medicine service in a general hospital of the Mexican Social Security Institute in the city of Tapachula, State of Chiapas. One hundred children were studied with a capillary hemoglobin (Hb) determination: 91 had anemia (Hb less than or equal to 11 g/dL). Sixty eight of the anemic children received oral iron for 3 months (3 mg/kg/day): their Hb before and after iron therapy were compared. Considering as responders those with an increment in Hb greater than 1 g/dL, sixty four children (94%) showed a mean increment of 2.6 g/dL. Four were considered as non-responders: in 3 the iron supplementation was stopped due to infectious diseases; the fourth case had a Hb increment below 1 g/dL. The use of capillary Hb as a criterium for treating anemic children proved to be a good predictor of response in a population where the prevalence of iron deficiency is high.

[Elective appendectomy associated with cesarean section]. / Apendicectomía electiva asociada a cesárea.

A prospective study was conducted in 90 patients divided in two different groups: the first group included 45 labor patients operated of cesarean section and elective appendectomy, the second group included 45 labor patients operated of cesarean section without appendectomy (control group). The purpose was to evaluate if the elective removal of the appendix increase the postoperative morbidity. The most common indication of cesarean section was the mother-fetus disproportion (55.5%). The main type of uterine incision was the segmental transverse (over 90% of the cases). Appendectomy added 11.2 minutes to the operation time, as compared with the control group (p less than 0.01). There were 4 cases (8.8%) of decidual infection in the appendectomy group and 2 cases (4.4%) of decidual infection (one of these complicated with wound dehiscence) in the control group. Nevertheless there was not difference statistically significative in comparing the morbidity between the groups (p = 0.33). There were no complications directly attributable to elective appendectomy. It is concluded that the elective appendectomy does not increase the postoperative morbidity in labor patients undergoing cesarean section and it requires a good selection of patients to be appendectomized.

Geographic distribution, evolution, and disease importance of species within the Neotropical Anopheles albitarsis Group (Diptera, Culicidae).

The Anopheles albitarsis group of mosquitoes comprises eight recognized species and one mitochondrial lineage. Our knowledge of malaria vectorial importance and the distribution and evolution of these taxa is incomplete. We constructed ecological niche models (ENMs) for these taxa and used hypothesized phylogenetic relationships and ENMs to investigate environmental and ecological divergence associated with speciation events. Two major clades were identified, one north (Clade 1) and one south (Clade 2) of the Amazon River that likely is or was a barrier to mosquito movement. Clade 1 species occur more often in higher average temperature locations than Clade 2 species, and taxon splits within Clade 1 corresponded with a greater divergence of variables related to precipitation than was the case within Clade 2. Comparison of the ecological profiles of sympatric species and sister species support the idea that phylogenetic proximity is related to ecological similarity. Anopheles albitarsis I, An. janconnae, and An. marajoara ENMs had the highest percentage of their predicted suitable habitat overlapping distribution models of Plasmodium falciparum and P. vivax, and warrant additional studies of the transmission potential of these species. Phylogenetic proximity may be related to malaria vectorial importance within the Albitarsis Group.