Novel Aspects of cAMP-Response Element Modulator (CREM) Role in Spermatogenesis and Male Fertility.

Spermatogenesis is a very complex process with an intricate transcriptional regulation. The transition from the diploid to the haploid state requires the involvement of specialized genes in meiosis, among other specific functions for the formation of the spermatozoon. The transcription factor cAMP-response element modulator (CREM) is a key modulator that triggers the differentiation of the germ cell into the spermatozoon through the modification of gene expression. CREM has multiple repressor and activator isoforms whose expression is tissue-cell-type specific and tightly regulated by various factors at the transcriptional, post-transcriptional and post-translational level. The activator isoform CREMτ controls the expression of several relevant genes in post-meiotic stages of spermatogenesis. In addition, exposure to xenobiotics negatively affects CREMτ expression, which is linked to male infertility. On the other hand, antioxidants could have a positive effect on CREMτ expression and improve sperm parameters in idiopathically infertile men. Therefore, CREM expression could be used as a biomarker to detect and even counteract male infertility. This review examines the importance of CREM as a transcription factor for sperm production and its relevance in male fertility, infertility and the response to environmental xenobiotics that may affect CREMτ expression and the downstream regulation that alters male fertility. Also, some health disorders in which CREM expression is altered are discussed.

Temporal variation in methane emissions in a shallow lake at a southern mid latitude during high and low rainfall periods.

The global methane (CH4) emission of lakes is estimated at between 6 and 16 % of total natural CH4 emissions. However, these values have a high uncertainty due to the wide variety of lakes with important differences in their morphological, biological, and physicochemical parameters and the relatively scarse data from southern mid-latitude lakes. For these reasons, we studied CH4 fluxes and CH4 dissolved in water in a typical shallow lake in the Pampean Wetland, Argentina, during four periods of consecutive years (April 2011-March 2015) preceded by different rainfall conditions. Other water physicochemical parameters were measured and meteorological data were reported. We identified three different states of the lake throughout the study as the result of the irregular alternation between high and low rainfall periods, with similar water temperature values but with important variations in dissolved oxygen, chemical oxygen demand, water turbidity, electric conductivity, and water level. As a consequence, marked seasonal and interannual variations occurred in CH4 dissolved in water and CH4 fluxes from the lake. These temporal variations were best reflected by water temperature and depth of the Secchi disk, as a water turbidity estimation, which had a significant double correlation with CH4 dissolved in water. The mean CH4 fluxes values were 0.22 and 4.09 mg/m2/h for periods with low and high water turbidity, respectively. This work suggests that water temperature and turbidity measurements could serve as indicator parameters of the state of the lake and, therefore, of its behavior as either a CH4 source or sink.

[Endoscopic submucosal dissection in early gastric cancer: Experience in 16 patients]. / Disección submucosa endoscópica en cáncer gástrico incipiente: experiencia inicial en el Hospital Clínico de la Pontificia Universidad Católica de Chile.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a minimally invasive procedure that allows curative treatment of early gastric cancer (EGC) in selected patients. AIM: To report our initial experience with ESD. MATERIAL AND METHODS: Analysis of prospective data from 16 patients aged 61 to 84 years, who underwent ESD between December 2011 and June 2014. Tumor type, operative time, hospitalization length, oncologic outcomes, complications and short-term follow up were registered. RESULTS: En-block resection was achieved in all cases. The median operative time was 135 min (range: 50-320 min). Specimens' median size was 3.5 cm (range: 3-10). All the resections were R0. In 14 patients ESD was considered curative. In two patients, ESD was considered potentially non-curative due to the presence pathological risk factors for lymph-node metastases in the biopsy specimen. Both patients underwent laparoscopic gastrectomy with lymph-node dissection. There was one case of gastric wall perforation that was repaired by laparoscopic suture. There was no mortality. The median follow-up time was 15 months (range: 2-30 months). CONCLUSIONS: ESD is a feasible and safe procedure in our institution with good results in this initial experience.

Population Pharmacokinetics of Sertraline in Psychiatric and Substance Use Disorders.

This study aimed to characterize the population pharmacokinetics of sertraline in Mexican patients with psychiatric and substance use disorders. Fifty-nine patients (13 to 76 years old) treated with doses of sertraline between 12.5 and 100 mg/day were included. Plasma sertraline concentrations were determined in blood samples and five of the main substances of abuse were determined by rapid tests in urine samples. Demographic, clinical, and pharmacogenetic factors were also evaluated. Population pharmacokinetic analysis was performed using NONMEM software with first-order conditional estimation method. A one-compartment model with proportional residual error adequately described the sertraline concentrations versus time. CYP2D6*2 polymorphism and CYP2C19 phenotypes significantly influenced sertraline clearance, which had a population mean value of 66 L/h in the final model. The absorption constant and volume of distribution were fixed at 0.855 1/h and 20.2 L/kg, respectively. The model explained 11.3% of the interindividual variability in sertraline clearance. The presence of the CYP2D6*2 polymorphism caused a 23.1% decrease in sertraline clearance, whereas patients with intermediate and poor phenotype of CYP2C19 showed 19.06% and 48.26% decreases in sertraline clearance, respectively. The model was internally validated by bootstrap and visual predictive check. Finally, stochastic simulations were performed to propose dosing regimens to achieve therapeutic levels that contribute to improving treatment response.

Mortality after emergency department discharge: an analysis of 453599 cases. / Mortalidad tras el alta desde el servicio de urgencias hospitalario: análisis de 453.599 episodios.

OBJECTIVES: To quantify and analyze mortality in patients who die within 30 days of discharge home from a hospital emergency department (ED). MATERIAL AND METHODS: All patients older than 14 years of age who were discharged home from the ED of a tertiary care hospital over a 5-year period were included. We collected age, sex, and other demographic variables, as well as the Charlson Comorbidity Index (CCI). The outcome variables of interest were 7-day and 30-day mortality and cause of death. Deaths were classified as expected and directly related to the emergency, expected but not directly related, unexpected and directly related, and unexpected and not directly related. A death was classified as an adverse event if it was directly related to a problem of diagnosis or management in the ED, underestimation of severity, or complications of a procedure. RESULTS: Of 519312 patients attended in the ED, 453 599 were discharged home. Of those discharged, 148 died at home within 7 days (32.63 deaths/100 000 discharges) and 355 died within 30 days (78.48 deaths/100 000 discharges). One hundred thirteen deaths (31.8%) were expected and related to the emergency 24.91/100 000), 169 (47.6%) were expected but unrelated 37.26/100 000), 4 (1.1%) were unexpected and related 1.10/100000), and 69 (19.4%) were unexpected and unrelated 15.21/100000). Deaths were considered adverse events related to ED care in 24.2% of the cases. Underestimation of severity was responsible for the highest proportion (10.7%) of such deaths. The median age of patients who died was 83 years, and the median Charlson comorbidity index (CCI) was 6. The most common cause of death was a malignant tumor (23.0%), followed by congestive heart failure (20.2%) and atherosclerotic cardiovascular disease (13.2%). Unexpected deaths related to ED care were significantly related to a higher proportion of adverse events related to diagnosis (P = .001), management (P = .004), and underestimation of severity (P .001). CONCLUSION: Early deaths after discharge home from a hospital ED occured in patients of advanced age with concomitant conditions. The main clinical settings were neoplastic and cardiovascular disease. Seven-day and 30-day mortality rates directly related to the emergency visit were low. Adverse events related to ED care played a role in about a quarter of the deaths after discharge.

OBJETIVO: Cuantificar y analizar la mortalidad de los pacientes dados de alta directamente desde un servicio de urgencias hospitalario (SUH) y que fallecen dentro de los primeros 30 días en el domicilio. METODO: Se incluyeron todos los pacientes mayores de 14 años dados de alta desde el SUH a domicilio durante 5 años en un hospital terciario. Se recogieron como variables demográficas, edad, sexo e índice de Charlson. Como variable evolutiva se investigó la mortalidad a 30 días, y si esta ocurrió en 7 o menos días o más de 7 días y la causa del fallecimiento. La mortalidad se clasificó como esperada y directamente relacionada, esperada y no directamente relacionada, no esperada y directamente relacionad, y no esperada y no directamente relacionada. Se determinó como evento adverso (EA) relacionada con la mortalidad si la muerte estaba relacionada con un problema diagnóstico o de manejo, de infraestimación de la gravedad o complicaciones del procedimiento. RESULTADOS: Fueron atendidos 519.312 episodios de los que 453.599 fueron dados de alta al domicilio. De estos, 148 fallecieron en domicilio a los 7 días (32,63/100.000 altas) y 355 fallecieron en los 30 días después del alta (78,48/100.000 altas): el 31,8% (n = 113) fueron fallecimientos esperados y relacionados (24,91/100.000 altas), el 47,6% (n = 169) esperados y no relacionados (37,26/100.000 altas), el 1,1% (n = 4) no esperados y relacionados (1,10/100.000 altas) y 19,4% (n = 69) no esperados y no relacionados (15,21/100.000 altas). En un 24,2% de los pacientes se detectaron EA relacionados con la asistencia en urgencias, el más frecuente EA fue la infraestimación de la gravedad (10,7%). La mediana de edad de los pacientes fallecidos era de 83 años y una mediana del índice de comorbilidad de Charlson (ICC) de 6 puntos. La principal etiología de fallecimiento fue la neoplasia maligna (23,0%), seguida de insuficiencia cardiaca congestiva (20,2%) y enfermedad cardiaca arteriosclerótica (13,2%). En los fallecimientos no esperados y relacionados, destaca una mayor proporción de EA por causa de problemas diagnósticos (p = 0,015), de manejo (p = 0,028) y de infraestimación de la gravedad (p = 0,004). CONCLUSIONES: Los pacientes que fallecen de forma precoz tras el alta de SUH en el domicilio son ancianos con comorbilidad y donde las principales causas de muerte son las enfermedades neoplásicas y las enfermedades cardiacas. Las muertes no esperadas y directamente relacionadas son poco frecuentes a los 7 y 30 días del alta. En una cuarta parte de los pacientes se detectaron EA relacionados con la asistencia en urgencias.

Development and evaluation of ciprofloxacin local controlled release materials based on molecularly imprinted polymers.

The aim of this study was the molecular imprinting polymers (MIPs) assessment as a controlled release system of ciprofloxacin. The MIPs synthesis was performed by three different methods: emulsion, bulk, and co-precipitation. Lactic acid (LA) and methacrylic acid (MA) were used as functional monomers and ethylene glycol dimethacrylate as crosslinker. Also, nonimprinted polymers (NIPs) were synthesized. MIPs and NIPs were characterized by scanning electron microscopy, Fourier Transform Infrared Reflection, specific surface area, pore size, and release kinetics. Their efficiency against Staphylococcus aureus and Escherichia coli, and their cytotoxicity in dermal fibroblast cells were proven. Results show that MIPs are mesoporous materials with a pore size between 10 and 20 nm. A higher adsorption with the co-precipitation MIP with MA as a monomer was found. The release kinetics proved that a non-Fickian process occurred and that the co-precipitation MIP with LA presented the highest release rate (90.51 mg/L) in 8 h. The minimum inhibitory concentration was found between 0.031 and 0.016 mg/L for Staphylococcus aureus and between 0.004 and 0.031 mg/L for the Escherichia coli. No cytotoxicity in cellular cultures was found; also, cellular growth was favored. This study demonstrated that MIPs present promising properties for drug administration and their application in clinical practice.

[Results of bariatric surgery. Experience over 18 years]. / Experiencia de 18 años de cirugía de obesidad en la Pontificia Universidad Católica de Chile.

BACKGROUND: Bariatric surgery is the gold-standard treatment for morbid obesity because it has low morbidity rates in high-volume centers and generates long term sustained weight loss. AIM: To describe our experience in bariatric surgery since the creation of our bariatric program in 1992. MATERIAL AND METHODS: Retrospective analysis of all patients subjected to bariatric surgery from 1992 to December 2010. Data was obtained from the electronic institutional registry. The Procedures per-formed were open and laparoscopic Roux-en-Y gastric bypass (BPGA and BPGL, respectively), laparoscopic adjustable gastric band (BGAL) and laparoscopic sleeve gastrectomy (GML). RESULTS: A total of 4943 procedures were performed, 768 (16%) BPGA, 2558 (52%) BPGL, 199 (4%) BGAL and 1418 (29%) GML. The number of procedures progressively increased, from 100 cases in 2000 to over 700 cases in 2008. Proportion of femóles and preoperative mean body mass Índex fluctuated between 69 and 79% and 35 and 43 kg/m², respectively, among the different procedures. Early and late complications fluctuated between Oto 1% (higher on BPGA) and 3 to 32.7% (higher on BGAL), respectively. The excess weight lost at five years was 76.1% in BPGA, 92.5% in BPGL and 53.7% in BGAL. The figure for GML at three years was 73.7%. CONCLUSIONS: The complication rates of this series of patients are similar to those reported in large series abroad. BPGL is still the most effective procedure; however GML is an attractive alternative for less obese patients.

Weight loss and metabolic improvement in morbidly obese subjects implanted for 1 year with an endoscopic duodenal-jejunal bypass liner.

OBJECTIVE: To evaluate safety, weight loss, and cardiometabolic changes in obese subjects implanted with the duodenal-jejunal bypass liner (DJBL) for 1 year. BACKGROUND: The DJBL is an endoscopic implant that mimics the duodenal-jejunal bypass component of the Roux-en-Y gastric bypass. Previous reports have shown significant weight loss and improvement in type 2 diabetes for up to 6 months. METHODS: Morbidly obese subjects were enrolled in a single arm, open label, prospective trial and implanted with the DJBL. Primary endpoints included safety and weight change from baseline to week 52. Secondary endpoints included changes in waist circumference, blood pressure, lipids, glycemic control, and metabolic syndrome. RESULTS: The DJBL was implanted endoscopically in 39 of 42 subjects (age: 36 ± 10 years; 80% female; weight: 109 ± 18 kg; BMI: 43.7 ± 5.9 kg/m); 24 completed 52 weeks of follow-up. Three subjects could not be implanted due to short duodenal bulb. Implantation time was 24 ± 2 minutes. There were no procedure-related complications and there were 15 early endoscopic removals. In the 52-week completer population, total body weight change from baseline was -22.1 ± 2.1 kg (P < 0.0001) corresponding to 19.9 ± 1.8% of total body weight and 47.0 ± 4.4% excess of weight loss. There were also significant improvements in waist circumference, blood pressure, total and low-density lipoprotein cholesterol, triglycerides, and fasting glucose. CONCLUSIONS: The DJBL is safe when implanted for 1 year, and results in significant weight loss and improvements in cardiometabolic risk factors. These results suggest that this device may be suitable for the treatment of morbid obesity and its related comorbidities. This study was registered at www.clinicaltrials.gov (NCT00985491).

Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study.

INTRODUCTION: The application of laparoscopic gastric surgery has rapidly increased for the treatment of early gastric cancer. However, laparoscopic gastrectomy for advanced tumor remains controversial, particularly in terms of oncologic outcomes. This study was designed to compare 3-year survival of laparoscopic versus open curative gastrectomy in early and advanced gastric cancer. METHODS: This was a retrospective matched cohort study. We included patients between 2003 and 2010 with an R0 resection. A totally laparoscopic technique was used and D2 lymph node dissection was practiced routinely. We performed an intracorporeal hand-sewn esophagojejunostomy in all laparoscopic total gastrectomy cases. We matched all laparoscopic cases 1:1 with open cases according to TNM AJCC seventh edition. We used Mann-Whitney or t test and Chi-square test to compare both groups. Kaplan-Meier analysis with log-rank test was performed to compare survival. RESULTS: We included 31 open and 31 laparoscopic cases (mean age 63 ± 14 years; 66% males). Both groups were identical in type of gastrectomy (71% total and 29% subtotal). There were no statistical difference between laparoscopic and open groups in age, sex, N category, tumor location and size, histological differentiation, and T category (48% T1, 13% T2, 16% T3, and 23% T4 in both groups), with 48% early and 52% advanced tumors. The median number of resected lymph nodes was similar: 35 (23-53) for laparoscopic and 39 (23-45) for open cases (P = 0.81). The median follow-up was 50 months. The overall 3-year survival was 82% for laparoscopic surgery and 87% for the open surgery group (P = 0.56). There were no difference in 3-year survival for the laparoscopic versus the open surgery groups for advanced tumors (74 vs. 75%, P = 0.88), N+ tumors (73 vs. 73%, P = 0.99) and for the different AJCC stages (stage 1: 94 vs. 100%, stage 2: 89 vs. 82%, and stage 3: 50 vs. 50%, P = 0.32, 0.83, and 0.98 respectively). CONCLUSIONS: In this preliminary report, with 52% of advanced tumor, the 3-year overall and stage-by-stage survival was comparable for laparoscopic and open curative gastrectomy.

End-of-life management of single-use baby diapers: Analysis of technical, health and environment aspects.

Single-use baby diapers belongs to an important group of products used in the parenting journey because of their high performance and convenience. Single-use baby diapers are normally thrown away after one-time use, resulting in a waste management problem. The goal of this paper was to better understand main environmental concerns of different types of diapers and address how to reduce them, with a special consideration of waste management strategies and user behaviour practices. Furthermore, health and environmental hazards potentially associated with materials included in diapers, or substances formed from diapers during the waste treatment stage, are also analysed (e.g., phthalates, pesticides, dioxins, pesticides). Three main types of baby diapers have been analysed: single-use baby diapers, reusable baby diapers, and biodegradable single-use diapers. Each type of diaper comes with technical characteristics and environmental concerns and challenges, which are discussed in this paper to support the development of measures for the safe(r) and sustainable design, use and end of life management of baby diapers.

UVR Exposure and Prevention of Street Construction Workers in Colombia and Germany.

(1) Solar ultraviolet radiation (UVR) poses a major risk factor for developing skin cancer after years of chronic exposure. The irradiation is strongly dependent upon the activity or occupation carried out, but also on the climate conditions at the workplace. Knowledge of both has been tested within the occupational group of road construction workers in Colombia and Germany. (2) The GENESIS-UV measurement system has been used at both locations for consistency. A number of workers in both countries wore an electronic data logging dosimeter for several months to deliver detailed information on UVR exposure. (3) It was found that in a tropical climate, UVR exposure remains constant throughout the year, while in a temperate climate seasonal effects are visible, superimposed by behavioural aspects e.g., in springtime. The daily distribution of the radiation shows a distinct dip, especially in the Colombian data. Derived data show the high fraction of working days exceeding a threshold set by the skin type. (4) Road construction work involves high UVR exposure. In both countries, preventive measures are required to reduce the personal exposure to a minimum. Exceedance of the minimal erythema dose (MED) suggests a possible enhancing effect, especially in fair skinned people. Intercomparison of UVR exposure at workplaces is possible between countries and climate zones, emphasizing efforts for global action against skin cancer.

Characterization of the promoter region of the murine Catsper2 gene.

CATSPER2 (Cation channel sperm-associated protein 2) protein, which is part of the calcium CATSPER channel located in the membrane of the flagellar principal piece of the sperm cell, is only expressed in the testis during spermatogenesis. Deletions or mutations in the Catsper2 gene are associated with the deafness-infertility syndrome (DIS) and non-syndromic male infertility. However, the mechanisms by which Catsper2 is regulated are unknown. Here, we report the characterization of the promoter region of murine Catsper2 and the role of CTCF and CREMτ in its transcription. We report that the promoter region has transcriptional activity in both directions, as determined by observing luciferase activity in mouse Sertoli and GC-1 spg transfected cells. WGBS data analysis indicated that a CpG island identified in silico is non-methylated; Chromatin immunoprecipitation (ChIP)-seq data analysis revealed that histone marks H3K4me3 and H3K36me3 are present in the promoter and body of the Catsper2 gene respectively, indicating that Catsper2 is subject to epigenetic regulation. In addition, the murine Catsper2 core promoter was delimited to a region between -54/+189 relative to the transcription start site (TSS), where three CTCF and one CRE binding site were predicted. The functionality of these sites was determined by mutation of the CTCF sites and deletion of the CRE site. Finally, ChIP assays confirmed that CREMτ and CTCF bind to the Catsper2 minimal promoter region. This study represents the first functional analysis of the murine Catsper2 promoter region and the mechanisms that regulate its expression.

["Follow up" strategy in the management of hospital stay]. / Estrategia de Follow up en la gestión de la estancia hospitalaria.

Background: In countries with emerging economies, the adequate and efficient management of resources is a priority, through strategies to reduce prolonged stay, increase the availability of beds, maximize profitability and reduce iatrogenic complications. Objective: The purpose of the study was to evaluate the effect of the "Follow up" strategy (FU) on the main indicators of the hospitalization process. Material and methods: A cross-sectional, comparative study was developed to evaluate the impact of the FU strategy on the indicators: hospital admissions and discharges, average days of hospital stay (DEH), percentage of hospital occupancy (OH), bed substitution interval (ISC), bed turnover rate (CRI) and prolonged hospital stay (EHP). Results: The FU was associated with a reduction in DEH [5.7 (5.5-6.1) vs. 6.5 days (6.1-6.9), p = 0.01]; ISC [0.6 (0.4-0.8) vs. 1.2 (0.8-1.3), p = 0.01] and EHP [23.6 (21.6-24.7) vs. 26.3% (24.4-28.7), p = 0.02] compared to the control group, with an increase in existence [1436 (1381-1472) vs. 1347 patient days (1280-1402), p = 0.02], respectively. There was no significant difference in the number of admissions, discharges or in the IRC. Conclusions: The FU reduces the average number of days of hospital stay, the rate of bed substitution and prolonged stay.

Introducción: en los países con economías emergentes es prioritaria la gestión adecuada y eficiente de los recursos hospitalarios. Las estrategias de gestión pueden reducir la estancia prolongada, aumentar la disponibilidad de camas, maximizar la rentabilidad y reducir las complicaciones iatrogénicas. Objetivo: el propósito del estudio fue evaluar el efecto de la estrategia de Follow up (FU) en los principales indicadores del proceso de hospitalización. Material y métodos: se desarrolló un estudio transversal, comparativo, para evaluar el impacto de la estrategia de FU en los indicadores: ingresos y egresos hospitalarios, promedio de días de estancia hospitalaria (DEH), porcentaje de ocupación hospitalaria (OH), intervalo de sustitución de camas (ISC), índice de rotación de camas (IRC) y estancia hospitalaria prolongada (EHP). Resultados: la estrategia de FU se asoció con una reducción de los DEH [5.7 (5.5-6.1) frente a 6.5 días (6.1-6.9), p = 0.01]; ISC [0.6 (0.4-0.8) frente a 1.2 (0.8-1.3), p = 0.01] y EHP [23.6 (21.6-24.7) frente a 26.3% (24.4-28.7), p = 0.02] respecto al grupo control, con incremento de la existencia [1436 (1381-1472) frente a 1347 días paciente (1280-1402), p = 0.02], respectivamente. No hubo diferencia significativa en el número de ingresos, egresos ni en el IRC. Conclusiones: la estrategia de FU disminuyó el promedio de días de estancia hospitalaria, el índice de sustitución de camas y la estancia prolongada.

Laparoscopic adjustable gastric banding (LAGB): surgical results and 5-year follow-up.

BACKGROUND: LAGB is a technique increasingly used in the USA. The aim of this study is to analyze the 5-year outcome in terms of weight loss and complications. METHOD: We reviewed our prospective electronic database for all patients undergoing LAGB between 2002 and 2007. We assessed weight progression, complications, and reoperations. RESULTS: We performed 199 cases during this period (70.4% females). Mean age was 37.8 ± 12.4 years. Preoperative body mass index (BMI) was 36.0 ± 3.8 kg/m(2). Preoperative comorbidities were dyslipidemia in 52.3%, insulin resistance in 30.7%, arterial hypertension in 24.6%, and type 2 diabetes in 5.5%. There were no conversions to open technique. Early complications were observed in two patients (1%): one hemoperitoneum and one ileitis. Mortality was 0%. Late complication rate was 33.6% (18.0% related to the band). Reoperation was required in 40 patients (20.1%). Laparoscopic repositioning was done in seven patients, and port/reservoir revision was done in five patients. Band removal was required in 28 patients, due to inadequate weight loss in 9, slippage in 9, gastric erosion in 1, bowel obstruction in 1, acute stomach dilatation in 1, and food intolerance in 7. Twenty of these patients underwent revisional surgery: sleeve gastrectomy in 12 and laparoscopic Roux-en-Y gastric bypass in 8 cases. Unrelated band complication was seen in 15.6%, mainly due to anemia (7.5%), alopecia (4.5%), and cholelithiasis (3.5%). With a median follow-up of 48 months (1-72 months), 75, 60, and 95% of patients were available for follow-up at 1, 3, and 5 years, respectively. Mean percent excess weight loss (%EWL) at 1, 3, and 5 years was 58.8 ± 30.0%, 56.8 ± 35.0%, and 58.4 ± 46.6%, respectively. However, failure rate (%EWL <50%) at 1, 3, and 5 years was 40.4, 43.5, and 46.3%, respectively. CONCLUSIONS: LAGB has low perioperative morbidity. However, its late complications are significant, and inadequate weight loss can be as high as 46.3% after 5 years.

An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department.

To evaluate the effectiveness of an integrated emergency department (ED)/hospital at home (HH) medical care model in mild COVID-19 pneumonia and evaluate baseline predictors of major outcomes and potential savings. Retrospective cohort study with patients evaluated for COVID-19 pneumonia in the ED, from March 3 to April 30, 2020. All of them were discharged home and controlled by HH. The main outcomes were ED revisit and the need for deferred hospital admission (protocol failure). Outcome predictors were analyzed by simple logistic regression model (OR; 95% CI). Potential savings of this medical care model were estimated. Of the 377 patients attended in the ED, 109 were identified as having mild pneumonia and were included in the ED/HH medical care model. Median age was 50.0 years, 52.3% were males and 57.8% had Charlson index ≥ 1. The median HH stay was 8 (IQR 3.7-11) days. COVID-19-related ED revisit was 19.2% (n = 21) within 6 days (IQR 3-12.5) after discharge from ED. Overall protocol failure (deferred hospital admission) was 6.4% (n = 7), without ICU admission. The ED/HH model provided potential cost savings of 77% compared to traditional stay, due to the costs of home care entails 23% of the expenses generated by a conventional hospital stay. 789 days of hospital stay were avoided by HH, rather than hospital admission. An innovative ED/HH model for selected patients with mild COVID-19 pneumonia is feasible, safe and effective. Less than 6.5% of patients requiring deferred hospital admission and potential savings were generated due to hospitalization.

Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated?

BACKGROUND: Morbid obesity is associated with different gastrointestinal alterations and diseases. Surgically induced weight loss has become the best treatment for morbidly obese patients. Roux-en-Y gastric bypass is the most common procedure performed worldwide. Concerns regarding difficulties in further evaluation of stomach remnant for early detection of gastric cancer, however, have emphasized the routine use of preoperative upper endoscopy, even in asymptomatic patients, to detect upper gastrointestinal abnormalities. The main outcome of this study was to identify the most common preoperative endoscopic findings. METHODS: Data was collected from a prospective database and medical records of patients with available endoscopic reports, who underwent Roux-en-Y gastric bypass from February 1999 to June 2006. Logistic regression analysis was performed to detect preoperative clinical variables that might be associated with abnormal endoscopy. RESULTS: Six hundred twenty-six patients were identified. Four hundred fifty-two (72%) were female; age and body mass index were 38.5 +/- 11.3 years and 42 +/- 6.5 kg/m(2), respectively. Abnormalities were found in 288 (46%) patients. The age of patients with abnormal and normal endoscopy was 40 +/- 11 and 36.8 +/- 11 years, respectively (p < 0.001). The most common findings were gastritis 21% (n = 132), esophagitis 16% (n = 100), and hiatal hernia 10.7% (n = 67). Duodenitis has a frequency of 7.8% (n = 49), gastric ulcers of 2.7%(n = 17), duodenal ulcers of 2.6% (n = 16), gastric polyps of 1.3% (n = 8), Barrett's esophagus of 0.16% (n = 1), and gastric cancer of 0.16% (n = 1). Age was the only clinical variable associated to abnormal endoscopy (odds ratio = 1.03; 95% confidence interval, 1.02-1.05). CONCLUSIONS: Routine preoperative endoscopy detects different abnormalities which need specific approach prior to surgery. Preoperative endoscopy should be performed to all patients prior to surgery.

Atmospheric Methane Concentration Allows Estimating Natural Gas Leaks in Heating Systems in Tandil, Argentina.

Residential use of natural gas (NG) for heating and cooking purposes may contribute significantly to CH emissions to the atmosphere. To analyze whether the NG demand in the city of Tandil, Argentina, contributes to the increase in atmospheric CH concentration, we conducted systematic collections of time-integrated air samples for a year in six city sites with different population and built-up density. Some meteorological parameters and NG consumption were registered. Atmospheric CH concentration ranged from 1.12 to 1.95 mg m (1.72 to 2.84 ppm) with significant seasonal and spatial variations. In all the sites, with the exception of a peri-urban site bordering rural areas, the maximum CH concentrations were measured during the coldest months, with a statistically significant correlation between residential and commercial NG consumption with respect to air temperature ( < 0.001, = -0.84 to -0.69) and atmospheric CH concentration ( < 0.05, = 0.58 to 0.94). In Argentina, the most popular home heating system is the balanced-draft heater, which has a thermal efficiency of 39 to 63%. This low efficiency allows us to attribute the highest atmospheric CH concentration found during the coldest months mainly to the leaks of the heating systems and the greater residential use of NG. Repairing the gas leaks by increasing thermal efficiency or replacing heating systems with more efficient ones will bring economic, environmental, and health benefits. This study is important for our country where the dependence on the use of NG from heating systems is significant.

Routine preoperative ultrasonography and selective cholecystectomy in laparoscopic Roux-en-Y gastric bypass. Why not?

BACKGROUND: Preoperative evaluation and treatment of biliary lithiasis in morbid obese patients who are candidates to bariatric surgery raise a series of questions which to date has no clear consensus. The aim of this study was to evaluate the results of routine preoperative abdominal ultrasonography and selective cholecystectomy comparing patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP) with and without simultaneous cholecystectomy. METHODS: The prospective database of all the patients who underwent laparoscopic RYGBP in our institution was reviewed. The demographic characteristics, comorbidities, operative time, hospital stay, and postoperative complications were analyzed. RESULTS: From August 2001 to December 2006, 1,311 patients underwent laparoscopic RYGBP, 137 (10.4%) of them were excluded due to previous cholecystectomy. In 128 (10.9%) of the remaining 1,174 patients, a cholecystectomy associated to laparoscopic RYGBP was performed. The mean age was 38.5 +/- 10.1 years, and 106 (82.8%) were women. The mean operative time in patients with and without simultaneous cholecystectomy was 129.8 +/- 45 and 108.5 +/- 43 min, respectively (p < 0.001). The hospital stay was 3.6 +/- 0.8 days in patients with simultaneous cholecystectomy and 4 +/- 3 days in patients without simultaneous cholecystectomy (p = 0.003). There were no deaths. Postoperative complications were observed in 9 (7%) and 73 (6.9%) patients with and without simultaneous cholecystectomy respectively (p = NS). Postoperative complications were not related to the cholecystectomy. CONCLUSION: Cholecystectomy associated to laparoscopic RYGBP should be considered in all patients with preoperative ultrasound diagnosis of cholelithiasis.

Stigma: The relevance of social contact in mental disorder. / Estigma: la relevancia del contacto social en el trastorno mental.

INTRODUCTION: The stigma associated with mental illness is a health problem, discriminating and limiting the opportunities for sufferers. Social contact with people suffering a mental disorder is a strategy used to produce changes in population stereotypes. The aim of the study was to examine differences in the level of stigma in samples with social contact and the general population. METHOD: The study included two experiments. The first (n=42) included players in an open football league who played in a team with players with schizophrenia. In the second included, a sample without known contact (n=62) and a sample with contact (n=100) were compared. The evaluation tool used was AQ-27, Spanish version (AQ-27-E). The mean difference between the two samples of each of the 9 subscales was analyzed. RESULTS: In the first experiment, all the subscales had lower scores in post-contact than in pre-contact, except for responsibility. The two subscales that showed significant differences were duress (t=6.057, p=.000) and Pity (t=3.661, p=.001). In the second experiment, seven subscales showed a significance level (p=<.05). Segregation and responsibility and did not. CONCLUSIONS: It is observed that the social contact made in daily situations can have a positive impact on the reduction of stigma. This can help to promote equality of opportunity.

Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the most common surgical treatment for morbid obesity. Intestinal obstruction and internal hernias are complications more commonly observed after LRYGB than after open RYGB. The aim of this study was to evaluate the incidence of these complications in patients who had undergone LRYGB using an antecolic versus a retrocolic technique. METHODS: From August 2001 to August 2005, LRYGB was performed in 754 patients. The retrocolic and antecolic technique was used in 300 and 454 consecutive patients, respectively. The mean patient age was 37 +/- 10 years, and 552 of the patients (73%) were women. The mean preoperative body mass index was 41.3 +/- 5 kg/m2. The median follow-up was 16 months. RESULTS: During follow-up, 36 patients (4.7%) underwent surgical exploration secondary to intestinal obstruction. This complication was observed in 28 (9.3%) and 8 (1.8%) patients in the retrocolic and antecolic technique groups, respectively (P <.001). In the retrocolic technique group, an internal hernia developed in 24 patients compared with 3 patients in the antecolic technique group. On multivariate analysis, the retrocolic technique was identified as a risk factor (P <.001). CONCLUSION: A greater incidence of intestinal obstruction and internal hernia was observed in the retrocolic technique group than in the antecolic technique group undergoing LRYGB. The results of our study have shown that the use of the retrocolic technique is a risk factor for intestinal obstruction after LRYGB.