Factors of poor prognosis in newborns with a prenatal diagnosis of gastroschisis in Bogota, Colombia.

OBJECTIVES: To identify factors associated with poor prognoses in newborns with a prenatal diagnosis of gastroschisis in eight hospitals in Bogota, Colombia, from 2011 to 2022. METHODS: A multi-center retrospective case-control study was conducted on newborns with gastroschisis in eight hospitals in Bogota, Colombia. Poor prognosis was defined as the presence of sepsis, intestinal complications, or death. RESULTS: The study included 101 patients. Preterm newborns under 32 weeks had a poor neonatal prognosis (OR 6.78 95 % CI 0.75-319). Oligohydramnios (OR 4.95 95 % CI 1.15-21.32) and staged closure with silo (OR 3.48; 95 % CI 1.10-10.96) were risk factors for neonatal death, and intra-abdominal bowel dilation of 20-25 mm was a factor for the development of intestinal complications (OR 3.22 95 % CI 1.26-8.23). CONCLUSIONS: Intra-abdominal bowel dilation between 20 and 25 mm was associated with intestinal complications, while oligohydramnios was associated with the risk of perinatal death, requiring increased antenatal surveillance of fetal wellbeing. Management with primary reduction when technically feasible is recommended in these infants, considering that the use of silos was associated with higher mortality.

Effect of probiotics on glucose levels and weight gain in mice exposed to low doses of malathion.

INTRODUCTION: Owing to its ability to reduce the toxicity of environmental pollutants that are risk factors for diabetes and obesity, the use of probiotic bacteria might aid the treatment of these diseases. OBJECTIVE: To determine the effects of chronic exposure to low-dose malathion on weight and glucose levels in mice, as well as to evaluate the protective role of a probiotic supplement. METHODS: Weight and serum glucose levels of four groups of mice (control, malathion-exposed [10 ppm], probiotics and malathion + probiotics) were determined every 10 days for 180 days. RESULTS: Malathion administration induced an increase in weight and glucose levels in the malathion group mice in comparison with the other groups. CONCLUSIONS: Consumption of food contaminated with malathion residues increases glucose levels and favors weight gain, while consumption of probiotics reduces the effects generated by residues in food.

INTRODUCCIÓN: Debido a su capacidad para reducir la toxicidad de contaminantes ambientales que constituyen factores de riesgo de diabetes y obesidad, el uso de bacterias probióticas podría ayudar al tratamiento de esas enfermedades. OBJETIVO: Determinar los efectos de la exposición crónica a malatión a dosis bajas sobre el peso y los niveles de glucosa de ratones, así como evaluar el papel protector de un suplemento probiótico. MÉTODOS: Cada 10 días se determinó el peso y la glucosa sérica de cuatro grupos de ratones (de control, expuestos a malatión (10 ppm), probióticos y malatión + probióticos) durante 180 días. RESULTADOS: La administración de malatión provocó un incremento del peso y los niveles de glucosa en los ratones del grupo con malatión comparados con los demás grupos. CONCLUSIONES: El consumo de alimentos contaminados con residuos de malatión aumenta los niveles de glucosa y favorece el incremento del peso; el consumo de probióticos disminuye los efectos generados por los residuos en los alimentos.

Impact of the new kidney allocation system A2/A2B → B policy on access to transplantation among minority candidates.

Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013 to 2017 was performed, as reported to the Scientific Registry of Transplant Recipients. Cases were defined as recipients of A2/A2B kidneys, whereas controls were all remaining recipients of non-A2/A2B kidneys. A2i DDKT trends were compared from the pre-KAS (1/1/2013-12/3/2014) to the post-KAS period (12/4/2014-2/28/2017) using multivariable logistic regression. Post-KAS, there was a 4.9-fold increase in the likelihood of A2i DDKT, compared to the pre-KAS period (odds ratio [OR] 4.92, 95% confidence interval [CI] 3.67-6.60). However, compared to whites, there was no difference in the likelihood of A2i DDKT among minorities post-KAS. Although KAS resulted in increasing A2/A2B→B DDKT, the likelihood of A2i DDKT among minorities, relative to whites, was not improved. Further discussion regarding A2/A2B→B policy revisions aiming to improve DDKT access for minorities is warranted.

Operative start times and complications after kidney transplantation.

The worldwide focus on work hour regulations and patient safety has led to the re-examination of the merits of night-time surgery, including kidney transplantation. The risks of operating during nontraditional work hours with potentially fatigued surgeons and staff must be weighed against the negative effects of prolonged cold ischemic time with resultant graft compromise. The aim of this study was to evaluate the impact of performing renal transplantation procedures during evening versus day time hours. The main outcome measures assessed between the day and night cohorts included comparisons of the postoperative complication rates and survival outcomes for both the renal allograft and the patient. A retrospective review of 633 deceased donor renal transplants performed at a single institution was analyzed. Three statistically significant results were noted, namely, a decrease in vascular complications in the nighttime cohort, an increase in urologic complications on subgroup analysis in the 3 AM to 6 AM cohort, and the 12 AM to 3 AM subgroup had the greatest odds of any complication. There was no statistical difference in either patient or graft survival over a twelve month period following transplantation. We conclude that although the complication rate varied among cohorts this was clinically insignificant and there was no overall clinically relevant impact on patient or graft survival.

Comparison of wire versus Nylon in Bonny-Mallet Finger treated with pull-out surgery.

INTRODUCTION: Zone I extensor tendon lesion accompanies an avulsion fracture of the bone insertion. A common complication of traditional pull-out is the necrosis of the site of the button in the finger pad. Zhang described an alternative way of anchoring the cerclage to the Kirschner Wire (K-wire) to relieve the pressure in the finger pad. He describes the use of wire cerclage, for fracture reduction. The objective of this paper is to perform a comparison between wire and nylon using Zhang pull-out technique. MATERIAL AND METHODS: We performed a cohort study comparing Nylon versus Wire in Zhang technique. Comparing cosmetic satisfaction, stiffness, residual pain, and Crawford scale. RESULTS: When comparing the outcomes between both groups, we found no statistical difference in cosmetic satisfaction (p = 0.285), stiffness (p = 0.460), and residual pain (p =1.000), overall complications (p = 1.000), or Crawford scale (p = 1.000). We only found a significant statistical difference in pain when removing the cerclage, being greater in Group B (p = 0.008). CONCLUSIONS: We found no significant outcome difference between nylon and wire cerclage. However, at the time of removing it, patients experience less pain.

INTRODUCCIÓN: Una complicación común del pull-put tradicional es la necrosis del sitio del botón en la yema del dedo. Zhang describió una forma alternativa de anclar el cerclaje al clavo de Kirschner para aliviar la presión en la yema del dedo. Describe el uso de cerclaje de alambre para la reducción de fracturas. El objetivo de este trabajo es realizar una comparación entre el alambre y el nailon utilizando la técnica de extracción de Zhang. MATERIAL Y MÉTODOS: Realizamos un estudio de cohorte comparando la técnica de nailon versus alambre en Zhang. Comparación de satisfacción cosmética, rigidez, dolor residual y escala de Crawford. RESULTADOS: Al comparar los resultados entre ambos grupos, no encontramos diferencias estadísticas en la satisfacción cosmética (p = 0.285), rigidez (p = 0.460) y dolor residual (p = 1.000), complicaciones generales (p = 1.000) o escala de Crawford (p = 1.000). Solo encontramos una diferencia estadística significativa en el dolor al retirar el cerclaje, siendo mayor en el Grupo B (p = 0.008). CONCLUSIONES: No encontramos diferencias significativas en los resultados entre el cerclaje de nailon y el cerclaje con alambre. Pero, al momento de retirarlo, los pacientes experimentan menos dolor. Tipo de estudio: terapéutico Nivel de evidencia III.

Intestinal obstruction secundary to gallstone ileus: case report.

Gallstone ileus is an intestinal obstruction that is secondary to the presence of gallstones in the small intestine. It is a rare complication of cholelithiasis, which represents 1-3% of the causes of intestinal obstruction. The diagnosis is difficult given that the symptoms are nonspecific with intermittent intestinal obstruction, Rigler's triad (pneumobilia, stone and abdominal distention) is pathognomonic. Among the diagnostic aids are abdominal radiography, ultrasound and abdominal tomography. Treatment should be individualized depending on the patient's conditions, with laparotomy with enterotomy being the treatment of choice.

El íleo biliar es una obstrucción intestinal secundaria a la presencia de cálculos biliares en el intestino delgado. Es una complicación rara de la colelitiasis y representa el 1-3% de las causas de obstrucción intestinal. El diagnóstico es difícil dado que la clínica es inespecífica, con un cuadro de oclusión intestinal intermitente; la tríada de Rigler (neumobilia, lito y distensión abdominal) es patognomónica. Dentro de los auxiliares diagnósticos se encuentran la radiografía de abdomen, el ultrasonido y la tomografía computarizada abdominal. El tratamiento debe individualizarse dependiendo de las condiciones del paciente, siendo de elección la laparotomía con enterotomía.

Plasmacytoid variant of urothelial carcinoma of the bladder manifesting as bilateral ureteral and small bowel obstruction.

Plasmacytoid urothelial carcinoma (PUC) is a rare variant of bladder cancer characterized by distinct histopathology and advanced stage at diagnosis. Multimodal treatment is usually indicated. We present a case of PUC causing bilateral ureteral obstruction with subsequent renal failure followed shortly by malignant small bowel obstruction, demonstrating the need for a high degree of clinical suspicion in diagnosis of this aggressive subtype. Moreover, the local invasiveness of the disease cannot be understated, given that it can rapidly spread with little radiologic evidence of progression until it is at an advanced stage.

Budd-Chiari syndrome: illustrated review of current management.

Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction at any level from the small hepatic veins to the atriocaval junction. BCS is a complex disease with a wide spectrum of aetiologies and presentations. This article reviews the current literature with respect to presentation, management and prognosis of the disease. Medical, interventional and surgical management of BCS is discussed. Particular attention is paid to interventional and surgical aspects of management. The review is augmented by images, which provide a clinical corollary to the text.

Efecto de los probióticos en los niveles de glucosa y el incremento de peso en ratones expuestos a dosis bajas de malatión / Effect of probiotics on glucose levels and weight gain in mice exposed to low doses of malathion

Resumen Introducción: Debido a su capacidad para reducir la toxicidad de contaminantes ambientales que constituyen factores de riesgo de diabetes y obesidad, el uso de bacterias probióticas podría ayudar al tratamiento de esas enfermedades. Objetivo: Determinar los efectos de la exposición crónica a malatión a dosis bajas sobre el peso y los niveles de glucosa de ratones, así como evaluar el papel protector de un suplemento probiótico. Métodos: Cada 10 días se determinó el peso y la glucosa sérica de cuatro grupos de ratones (de control, expuestos a malatión (10 ppm), probióticos y malatión + probióticos) durante 180 días. Resultados: La administración de malatión provocó un incremento del peso y los niveles de glucosa en los ratones del grupo con malatión comparados con los demás grupos. Conclusiones: El consumo de alimentos contaminados con residuos de malatión aumenta los niveles de glucosa y favorece el incremento del peso; el consumo de probióticos disminuye los efectos generados por los residuos en los alimentos.

Abstract Introduction: Owing to its ability to reduce the toxicity of environmental pollutants that are risk factors for diabetes and obesity, the use of probiotic bacteria might aid the treatment of these diseases. Objective: To determine the effects of chronic exposure to low-dose malathion on weight and glucose levels in mice, as well as to evaluate the protective role of a probiotic supplement. Methods: Weight and serum glucose levels of four groups of mice (control, malathion-exposed [10 ppm], probiotics and malathion + probiotics) were determined every 10 days for 180 days. Results: Malathion administration induced an increase in weight and glucose levels in the malathion group mice in comparison with the other groups. Conclusions: Consumption of food contaminated with malathion residues increases glucose levels and favors weight gain, while consumption of probiotics reduces the effects generated by residues in food.

Liver transplantation using an organ donor with HELLP syndrome.

BACKGROUND: The shortage of organs for liver transplantation has forced transplant centers to expand the donor pool by using donors traditionally labeled as marginal. One such example is liver transplantation using a donor with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), a disorder of late pregnancy that involves the liver as one of the target organs. METHODS: Two patients who died from complications of HELLP syndrome were evaluated for attempted multi-organ procurement. Donor characteristics, gross and microscopic liver findings, and procurement and transplant outcomes were reviewed. RESULTS: One of the liver allografts was successfully transplanted; the other was not procured because of poor macroscopic appearance. CONCLUSION: It is possible to successfully transplant the liver from a donor that succumbs to HELLP syndrome, provided there is adequate recovery of liver function before procurement.

Long-term outcome of controlled, non-heart-beating donor liver transplantation.

BACKGROUND: Previous reports have established the feasibility of using livers from controlled, non-heart-beating donors (CNHBD) with good immediate graft function. This has been largely borne out of necessity because of the donor shortage. METHODS: Retrospective database review for the last 7 years (1995-2002), encompassing 19 patients receiving CNHBD, with follow-up period of 1,000 +/- 694 days, median 762 days. Detailed review of recipient characteristics, operative and clinical course, immunosuppression, complications, survival rates, and comparison with the results obtained in patients receiving transplants of allografts procured in standard fashion, from heart-beating donors RESULTS: Kaplan-Meier patient survival rates were 100%, 89.5%, and 83.5% at 30 days, 1, and 2 years, respectively, which is not different from recipients of livers procured from heart-beating cadaveric donors (P=0.74, log-rank test). Five patients died at a mean follow-up time of 492 (range 46-1,103) days. The causes of death were related to secondary sclerosing cholangitis (n=1), cardiac failure (n=1), and sepsis (n=3). Two (10.5%) recipients underwent retransplantation, one for primary graft nonfunction and one because of biliary cast syndrome with cholangitis. Significant preservation damage (ALT>2,000) developed in five patients, but this did not affect survival. The incidence of vascular (15.6% vs. 9.6%, P=0.34) and biliary complications (10.55 vs. 13.8%, P=0.68) was no different than for those recipients receiving standard cadaveric donors. CONCLUSIONS: CNHBD safely expands the donor pool with similar long-term results as those obtained in patients receiving organs from brain-dead donors under standard procurement techniques.

Combined liver and pancreas procurement from a controlled non-heart-beating donor with aberrant hepatic arterial anatomy.

BACKGROUND: The critical shortage of transplantable organs has resulted in the use of extended donors, including non-heart-beating donors (NHBDs). Combined procurement of both a whole pancreas and a liver from a single cadaver is always anatomically feasible. However, when aberrant vasculature is present, the potential for vascular injury increases. Because the rapid flush technique is used in NHBD procurement, the inability to palpate arterial pulsation may also increase the chance of vascular damage. METHODS: We report a case of a successful combined procurement of hepatic, pancreatic, and renal grafts from a controlled NHBD with right replaced and left accessory hepatic arteries. RESULT: The liver and the pancreas were successfully transplanted to two different recipients in two different institutions without any complications. All grafts are functioning well at 14 months of follow-up. CONCLUSION: Safe procurement of both the liver and pancreas is possible from certain controlled NHBDs, even with aberrant anatomy.

Prevalence of metastases in hepatocellular carcinoma: risk factors and impact on survival.

The purpose of this study was to determine the prevalence and risk factors of metastases in hepatocellular carcinoma (HCC) patients and analyze the effects of different locations of metastases on survival. Retrospective analysis was performed on 347 HCC patients who received a metastatic workup including bone scan and computed tomography scans of chest, abdomen, and pelvis. Clinical and tumor characteristics were evaluated as risk factors for metastasis by univariate and multivariate methods. Survival was analyzed by Kaplan-Meier and Cox regression methods. One hundred forty-five patients had metastases: 72 had thoracic, 57 had abdominal, and 34 had bone metastases. Significant differences were noted with weight loss, hepatitis C, tumor grade, tumor multifocality, size, and alkaline phosphatase levels between the metastases group and the nonmetastases group by univariate analysis. Poor differentiation, multilobar spread, and size (> or = 5 cm) were strongest predictors of metastatic disease by logistic regression. Patients with thoracic metastases had significantly poorer survival. HCC metastasis is prevalent on initial presentation. Evaluation for liver transplantation or curative resection requires a full metastatic workup. Poor differentiation, larger tumors, and those with multilobar spread have increased risk for metastasis. Patients with thoracic spread have poor prognosis as compared to other locations of metastasis.

No benefit when placing drains after kidney transplant: a complex statistical analysis.

OBJECTIVES: This paper sought to determine if there were an association between drain placement and the incidence of wound complications. MATERIALS AND METHODS: A single-center institutional review board-approved retrospective study between 2001 to 2008, comparing 680 kidney transplant patients who either had a drain placed or were left undrained. Linear regression modeling was used to adjust the risk factors between the groups. Patients received calcineurin inhibitors, steroids, and a mycophenolate formulation. The incidence of early major and minor wound complications were captured. Minor wound complications were defined as seroma, lymphocele, and perigraft fluid collection, and major wound complications were defined as wound dehiscence, hematomas, evisceration, infections, wound necrosis, and hernias. Patients with incomplete data or those taking sirolimus were excluded. RESULTS: Six hundred eighty kidney transplant cases were reviewed. Four hundred seventy-nine received drains; 201 did not. Demographic analyses revealed that the drain group had a higher average value in age and body mass index. The drain group had a lower albumin and a lower mean platelet count after surgery. The number of patients without diabetes in the drain group numbered nearly twice as many as did those without drains. An attempt was made to statistically account for demographic differences. Seventy-eight of 479 drained patients (16.28%) and 24 of 201 no-drain patients (11.94%) had a wound complication. Minor wound complications were observed in 9 patients (1.88%) in the drain group and 6 in no-drain group (2.99%) (P = .3702). Major wound complications were observed in 58 patients in the drain group (12.18%) and 17 in the no-drain group (8.46%) (P = .1655). Drain placement had no effect on major or minor wound complications. CONCLUSIONS: Drain placement is not associated with major or minor wound complications in kidney transplants.

Successful Treatment of Rapid Onset, Symptomatic de novo Non-alcoholic Steatohepatitis Following Liver Transplantation: A Case Report.

A 45 year old female with a body mass index (BMI) of 24 underwent successful liver transplantation (LT) for alcoholic cirrhosis using a donor liver from an obese woman with microvesicular steatosis (80%) and minimal macrovesicular steatosis (5-10%) on liver biopsy. Ascites and hepatosplenomegaly developed soon after LT with progressive increase of serum alkaline phosphatase to 1340 IU/L while aspartate aminotransferase (AST), and alanine transaminase (ALT), and total bilirubin remained normal. Imaging showed marked hepatomegaly, extensive fatty infiltration of the liver, and compression of the hepatic veins with narrowing of the intrahepatic inferior vena cava (IVC). Liver biopsy on post-operative day 39 revealed 90-100% macrovesicular steatosis, steatohepatitis, and portal fibrosis. A hepatic venogram showed a 10 cm segment of intrahepatic IVC stenosis that was stented, improving portal venous pressure measurements. However, portal hypertension requiring diuretic therapy and multiple paracenteses remained. By 3 months after LT, her liver had grown to 22 cm, transaminases increased 2-4 times the upper limit of normal with a 2:1 AST to ALT ratio. Liver biopsy at post-LT day 82 showed no change in steatosis and steatohepatitis despite corticosteroid withdrawal and interval periportal and perisinusoidal fibrosis. 12 weeks after LT, the patient was found to have low apolipoprotein B (65 mg/dL), high-density lipoprotein (HDL) (<10 mg/dL), low-density lipoproteins (LDL) (9 mg/dL), and total cholesterol (<50 mg/dL) levels. Therapy was started for NASH with high dose (800 IU daily) vitamin E and pioglitazone 15 mg daily, and she received topical vegetable oil and oral essential fatty acid supplements. Liver enzymes normalized after 3 months and her lipid profile improved markedly (HDL 27 mg/dL, total cholesterol 128 mg/dL), with progressive decrease in liver size and resolution of ascites after 5 months of therapy. At 2 years post-LT, the liver enzymes remain normal and lipids have normalized.

Evaluating safety and efficacy of rabbit antithymocyte globulin induction in elderly kidney transplant recipients.

OBJECTIVES: The optimal immunosuppression regimen for elderly kidney transplant recipients is poorly defined. We sought to evaluate the short-term efficacy and safety of thymoglobulin in geriatric recipients of deceased-donor kidneys. MATERIALS AND METHODS: A single-center, retrospective analysis was undertaken between elderly (≥ 65 years) (n=137) and nonelderly (n=276) kidney transplant recipients who received rabbit antithymocyte globulin induction and calcineurin inhibitor, mycophenolic acid, and prednisone maintenance. RESULTS: The mean age was 70 versus 52 years. Fewer elderly patients had an earlier transplant or panel reactive antibodies > 20%, but had more machine perfused, older, and extended criteria donor kidneys. Elderly patients received lower rabbit antithymocyte globulin (5.4 vs 5.6 mg/kg; P = .04) and initial mycophenolic acid doses (1620 vs 1774 mg; P = .002), and experienced less delayed graft function (31.1% vs 50.0%; P < .001). Death-censored graft survival and graft function at 3 years and biopsy-proven acute rejection at 1 year were comparable; however, there was lower 3-year patient survival in elderly patients. Donor age was the only factor associated with reduced patient survival. Rates of malignancy, infection, or thrombocytopenia were similar; however, leukopenia occurred less frequently in elderly patients (11.7% vs 19.9%; P = .038). CONCLUSIONS: Elderly kidney transplant recipients receiving rabbit antithymocyte globulin did not experience different short-term graft survival, graft function or rates of infection, malignancy or hematologic adverse reactions than did nonelderly patients; they experienced fewer episodes of delayed graft function, but had lower 3-year patient survival.

Factores de riesgo para endometritis puerperal en pacientes que asisten para terminación del embarazo en el hospital Simón Bolivar entre enero 2007 a diciembre 2013 / Risk factors for puerperal endometritis in patients attending for termination of pregnancy at Simón Bolivar hospital between january 2007 to december 2013

La endometritis Posparto constituye la causa más frecuente de fiebre puerperal, y su incidencia aumenta con la presencia de ciertos factores de riesgo que se pueden encontrar en todos los niveles de atención de la gestante y su identificación, permitiría disminuir la morbimortalidad en los servicios de Ginecología y Obstetricia. OBJETIVO Determinar los factores de riesgo para endometritis puerperal en el servicio de Ginecología y Obstetricia del Hospital Simón Bolívar. MATERIALES Y MÉTODOS Se realizó un estudio observacional tipo analítico retrospectivo de casos y controles en el Hospital Simón Bolívar de la ciudad de Bogotá, en mujeres que asistieron durante el periodo comprendido entre Enero de 2007 a Diciembre de 2013 para terminación del embarazo durante el tercer trimestre. RESULTADOS Se analizaron un total 408 pacientes, 136 pacientes con endometritis postparto (casos) y 272 pacientes sin endometritis (controles), con una relación caso control de 1 caso por cada 2 controles. Al realizar el análisis de las variables a estudio como: paridad, ruptura de membranas, vía del parto, índice de masa corporal, revisión uterina, infección de vías urinarias y presencia de flujo vaginal, asociado a endometritis no mostraron resultados estadísticamente significativos. La asociación entre la edad de la madre, edad gestacional al momento del parto y preeclampsia evidenciaron un ligero aumento del riesgo para endometritis puerperal. CONCLUSIÓN Los principales factores de riesgo para endometritis puerperal encontrados entre las pacientes atendidas por servicio de Ginecología y Obstetricia del Hospital Simón Bolívar fueron gestantes de edad avanzada, pacientes con preeclampsia asociada y edad gestacional menor de 37 semanas al momento del parto. La vía de parto y la atención intraparto no tuvieron asociación ni aumento del riesgo de forma significativa.