Effect of bariatric surgery in the body burden of persistent and non-persistent pollutants: longitudinal study in a cohort of morbidly obese patients.

Introduction: Obesity is a pathological state that involves the dysregulation of different metabolic pathways and adipose tissue cells, constituting a risk factor for the development of other diseases. Bariatric surgery is the most effective treatment. The study of the behavior of pollutants in situations of extreme weight loss can provide biomonitoring information and tools to manage diseases of environmental etiology. Aim: To determine the prevalence of serum persistent and non-persistent pollutants in obese patients subjected to bariatric surgery and analyze the impact of sociodemographic variables on these changes. Methods: GC-MS/MS and UHPLC-MS/MS were utilized to determine the detection rates and concentrations of 353 compounds, including persistent organic pollutants (POPs), pesticides, pharmaceuticals, and rodenticide, in serum samples of 59 obese patients before and after undergoing bariatric surgery. Results: Detection rates of p,p'-DDE, HCB, ß-HCH, naphthalene, phenanthrene and PCB congeners 138, 153 and 180 significantly increased due to surgery-induced weight loss. Serum levels of p,p'-DDE, PCB-138, PCB-153 and PCB-180 also increased after surgery. Correlations between naphthalene levels, weight loss, variation of total lipids and time after surgery were found. Additionally, correlations were observed between concentrations of PCB-138 and weight loss, and between phenanthrene levels and reduction of total lipids. No statistically significant differences were observed for other groups of contaminants, pharmaceuticals and other chemicals included in the quantification methods. Conclusions: Increment of POPs was observed after bariatric surgery. Serum concentrations of POPs after surgery were influenced by adiposity-related variables. Although biomonitoring studies show a decreasing tendency of exposure, rapid weight loss leads to an increase of circulating POPs. Further research on the interplay between adipose tissue, POPs and peripheral organs is required.

Hemorrhagic shock secondary to ruptured hypogastric artery pseudoaneurysm. A rare complication of colorectal anastomotic leakage.

Massive bleeding due to rupture of hypogastric artery pseudoaneurysm is an exceptional complication of colorectal anastomotic leakage. A 41-year-old woman with history of rectal cancer surgery, who debuted with massive rectorrhagia and hypovolemic shock due to rupture of a hypogastric artery pseudoaneurysm as a late complication of a colorectal anastomosis leak. The ruptured hypogastric artery pseudoaneurysm should be taken into account in the differential diagnosis of patients with massive rectorrhagia and history of colorectal anastomosis leak. Endovascular embolization is considered the first-line treatment.

La hemorragia masiva por rotura de un pseudoaneurisma de la arteria hipogástrica es una complicación muy rara de la fuga anastomótica colorrectal. Mujer de 41 años con antecedentes de cirugía por cáncer de recto, que debutó con un cuadro de rectorragias masivo y shock hipovolémico secundario a la rotura de un pseudoaneurisma de la arteria hipogástrica como complicación tardía de una fuga de la anastomosis colorrectal. La rotura de un pseudoaneurisma de la arteria hipogástrica se debe tener presente en el diagnostico diferencial de pacientes con rectorragia masiva y antecedentes de dehiscencia de anastomosis colorrectal. La embolización endovascular es actualmente el tratamiento de elección.

Bariatric Surgery: An Opportunity to Improve Quality of Life and Healthy Habits.

Bariatric surgery therapy (BST) is an effective treatment for obesity; however, little is known about its impacts on health-related quality of life (HRQoL) and related factors. This study aimed to evaluate changes in HRQoL and its relationship with weight loss, depression status, physical activity (PA), and nutritional habits after BST. Data were obtained before and 18 months postprocedure from 56 obese patients who underwent BST. We administered four questionnaires: Short Form-36 health survey for HRQoL, 14-item MedDiet adherence questionnaire, Rapid Assessment of PA (RAPA) questionnaire, and Beck's Depression Inventory-II. Multivariable linear regression analysis was used to identify factors associated with improvement in HRQoL. After the surgery, MedDiet adherence and HRQoL improved significantly, especially in the physical component. No changes in PA were found. Patients without previous depression have better mental quality of life, and patients who lost more than 25% of %TBWL have better results in physical and mental quality of life. In the multivariable analysis, we found that %TBWL and initial PCS (inversely) were related to the improvement in PCS and initial MCS (inversely) with the MCS change. In conclusion, BST is an effective intervention for obesity, resulting in significant weight loss and improvements in HRQoL and nutritional habits.

Efectividad en reducción de unidades formadoras de colonias con soluciones desinfectantes en tina ultrasónica / Effectiveness in reducing colony forming units with disinfecting solutions in an ultrasonic vat

En la práctica clínica, los odontólogos se encuentran expuestos al riesgo de infecciones, que se transmiten a través de instrumentos contaminados con exudados. Instrumentos en contacto con el personal deben estar esterilizados o sometidos a un proceso de desinfección. Se realizó un estudio transversal-prospectivo a 30 pacientes, de los que se tomaron tres muestras con espejos estériles, pasando por fondo de saco, carrillos y lengua, después las muestras se desinfectaron, se realizó el hisopado de cada espejo y se incubó en agar tripticaseína-soya (TSA) 24 horas a 37 oC. Pasadas 24 horas se realizaron diluciones en tubos Eppendorf, y se sembraron en cajas de Petri con agar sangre, se incubaron por 48 horas a 37 oC; se contabilizaron las unidades formadoras de colonias (UFC) y registraron para su análisis. Al obtener los resultados se encontró que ID 213 tuvo mayor reducción con una media = 62.5 en comparación con Zeta 1 Ultra, media = 89.23, y control, media = 164.50, de igual manera se observó una diferencia en reducción de UFC/mL entre ID 213 con respecto a Zeta 1 Ultra con significancia de 0.012. Ambos desinfectantes resultaron efectivos, pero se estableció que ID 213 utilizando la tina ultrasónica resulta más efectivo en la reducción de UFC, que Zeta 1 Ultra (AU)

In clinical practice, dentists are exposed to the risk of infections, which are transmitted through instruments contaminated with exudates. Instruments in contact with personnel must be sterilized or subjected to a disinfection process. A cross-sectional-prospective study was carried out in 30 patients. From which three samples were taken with sterile mirrors, passing through cul-de-sac, cheeks and tongue, later the samples were disinfected with disinfectants, each mirror was swabbed and incubated in TSA 24 hours at 37 oC. After 24 hours, dilutions were made in Eppendorf tubes, and they were seeded in Petri dishes with blood agar, they were incubated 48 hours at 37 oC; CFUs were accounted for and recorded for analysis. When obtaining the results, it was found that ID 213 had a greater reduction with mean = 62.5 compared to Zeta 1 Ultra mean = 89.23 and control mean = 164.50, in the same way a difference in reduction of CFU/mL was observed between ID 213 with respect to Zeta 1 Ultra with significance of 0.012. Both disinfectants were effective but it was established that ID 213 using the ultrasonic tub is more effective in reducing CFU, than Zeta 1 Ultra (AU)

Factores de riesgo del cáncer cérvico uterino en adolescentes de la Universidad de Ciencias Médicas de Matanzas / Risk factors of cervical cancer in adolescents of the Matanzas University of Medical Sciences

RESUMEN Introducción: el cáncer cérvico uterino constituye un problema de salud para la humanidad. El estudio de sus factores de riesgo representa prioridad para el sistema de salud cubano. Objetivo: conocer el comportamiento de los factores de riesgo del cáncer cérvico uterino, en estudiantes de las carreras de Higiene-Epidemiología-Vigilancia y Lucha Antivectorial de la Universidad de Ciencias Médicas de Matanzas. Materiales y métodos: investigación descriptiva, transversal, retrospectiva que se insertó en el Programa Ramal Enfermedades Crónicas no Transmisibles. Se trabajó con el universo de 50 alumnos de las carreras de Higiene- Epidemiología-Vigilancia y Lucha Antivectorial de la Universidad de Ciencias Médicas de Matanzas. Resultados: según edad de inicio de las relaciones sexuales, se observó mayor predominio a los 14 años de edad. Presencia de múltiples compañeros sexuales, relaciones sexuales desprotegidas, uso de tabletas anticonceptivas, hábito de fumar, manipulaciones ginecológicas, así como infecciones de transmisión sexual. Especial significación tuvo la evidencia de cifras significativas de múltiples compañeros sexuales y el uso de tabletas anticonceptivas. Entre la distribución de motivos que impulsaron al inicio de relaciones sexuales, se destacaron los de experimentar sensaciones nuevas con el 28 %, y búsqueda de placer con la pareja en 55 %. El 92 %, desconocían los factores de riesgo de la enfermedad. Conclusiones: los estudiantes presentaron factores de riesgo de considerable magnitud de padecer cáncer cérvico uterino (AU).

SUMMARY Introduction: cervical cancer is a health problem for the humankind. The study of its risk factors stands as a priority for the Cuban health system. Objective: to know the behavior of cervical cancer risk factors in students of the studies of Hygiene-Epidemiology-Vector Surveillance and Control of the Matanzas University of Medical Sciences. Materials and methods: retrospective, cross-sectional, descriptive research inserted into the Branch Program of Chronic Non-communicable Diseases. It dealt with the universe of 50 students of the studies of Hygiene-Epidemiology-Vectorial Surveillance and Control of the Matanzas University of Medical Sciences. Results: in relation to the age of beginning to have sexual relationships, it was observed the predominance of the age of 14 years. The presence of multiple sexual partners, unprotected intercourse, use of contraceptive tablets, smoking habit, gynecological manipulations, and sexually transmitted infections are other risk factors found. Special significance had the existence of multiple sexual partners and the use of contraceptive tables. Among the motivations leading to early beginning to have sexual relationships, experiencing new sensations with 28 % and seeking for pleasure with the couple with 55 % stood out. 92 % did not know the disease's risk factors. Conclusions: the students presented pronounced magnitude risk factors of suffering cervical cancer (AU).

La habilidad para el manejo de la información científica en estudiantes de estomatología. Curso 2018-2019 / The ability for managing scientific information in Dentistry students. 2018-2019 school year

RESUMEN Introducción: las habilidades investigativas constituyen un aspecto esencial durante el proceso de formación del profesional de la Estomatología. Objetivo: diagnosticar el desarrollo de la habilidad para el manejo de la información científica en estudiantes de ciclo básico de la carrera de Estomatología. Materiales y Método: se realizó un estudio descriptivo de corte trasversal en el que participaron 43 estudiantes de primer y segundo año de la carrera de Estomatología curso (2018-2019) seleccionados a través de un muestreo intencional. Se empleó la revisión de documentos y un cuestionario sobre la percepción del dominio de la habilidad. Se evaluaron tres dimensiones fundamentales: cognitiva, valorativa y ejecutiva. Resultados: los estudiantes perciben tener mayor dominio de las acciones: consultar de fuentes de información, resumir, exponer ideas esenciales y emplear recursos informáticos. Las acciones menos dominadas resultaron ser el empleo de citas y referencias de acuerdo a las normas de Vancouver, la confección del informe final de revisión bibliográfica y la identificación de fuentes de información científica. Existe diversidad temática en las revisiones bibliográficas realizadas por los estudiantes y las principales vías de divulgación de la información son el trabajo de curso y las jornadas científicas estudiantiles, aunque menos de la mitad de los estudiantes valora de forma positiva la experiencia en la realización de investigaciones. Conclusión: se evidencia un adecuado dominio de la habilidad en correspondencia con los objetivos declarados en el Plan de estudio. No obstante, resulta necesario generar acciones educativas que contribuyan a satisfacer las necesidades de aprendizaje que persisten y a enriquecer las experiencias investigativas estudiantiles (AU).

SUMMARY Introduction: research abilities are an essential aspect during the training of the Dentistry professional. Objective: to diagnose the development of the ability to handle scientific information in students of the basic cycle of the Dentistry specialty. Materials and method: a descriptive cross-sectional study was carried out with the participation of 43 first and second year students of the Dentistry specialty in the 2018-2019 school year, chosen through an intentional sampling. Document reviewing and a questionnaire on the perception of the ability domain. Three main dimensions were assessed: cognitive, evaluative and executive. Results: the students perceive to have bigger mastery of the actions: consulting information sources, summarizing; presenting essential ideas and using computing resources. The less mastered actions turned out to be the use of citations and references according to Vancouver standards, writing the final bibliographic review report up and the identification of scientific information sources. There is thematic diversity in the bibliographic reviews carried out by students and the main ways of disseminating information are course work and student scientific conferences, although less than half of the students positively values the experience in conducting research. Conclusions: An adequate mastery of the ability is evidenced in correspondence with the objectives stated in the curriculum. However, it is necessary to generate educational actions contributing to satisfying the persisting learning needs and increasing the students' research experiences (AU).

Cirugía mínimamente invasiva de tumoración quística abdominal gigante en paciente puérpera / Minimally invasive surgery of a giant abdominal cyst tumor in a puerperal patient

La incidencia de masas anexiales diagnosticadas durante el embarazo varía según las diferentes series consultadas; sin embargo, masas de tamaño superior a 6 cm suponen casos excepcionales en la literatura. El manejo de este tipo de pacientes supone un reto para el equipo multidisciplinario, ya que se debe tener en cuenta el riesgo de cáncer de ovario en este tipo de pacientes. Se trata de una gestante de 34 años a la que se le diagnostica una masa anexial gigante durante el control ecográfico del primer trimestre. Ante la ausencia de sufrimiento fetal y teniendo en cuenta las características radiológicas de la lesión, se decide mantener una actitud expectante a la espera de un parto vía vaginal y poder realizar una cirugía electiva para la exéresis de la lesión. Tras el parto, la paciente sufre una anemización progresiva, por lo que se decide priorizar la intervención quirúrgica. Se llevó a cabo una exéresis de la masa mediante un abordaje mínimamente invasivo. Tanto la paciente como el recién nacido, tuvieron una evolución favorable. La paciente fue dada de alta tres días después de la cirugía(AU)

The incidence of adnexal masses diagnosed in pregnancy varies by the different consulted series; however, over 6cm long masses represent exceptional cases in literature. The management of this type of patients is a challenge for the multidisciplinary team since the risk of ovarian cancer should be taken into consideration in this type of patients. This is a 34 years-old pregnant patient who was diagnosed with giant adnexal mass during the echographic control of the first trimester. Due to the lack of fetal distress and the radiological characteristics of the lesion, it was decided to keep surveillance to wait for the vaginal delivery and to perform an elective surgery to remove the lesion. After the childbirth, the patient suffered a process of anemia, so it was decided to prioritize surgery. The mass was excised through a minimally invasive approach. Both the mother and the newborn had favorable recovery and the patient was discharged from hospital three days after surgery(AU)

Left-sided appendicitis: diagnosis and minimally invasive treatment / Left-sided appendicitis: diagnosis and minimally invasive treatment.

Intestinal malrotation and situs inversus can have important repercussions if acute abdominal pain develops. Intraabdominal structures can have inverted position and thus may easily mislead the surgeon during physical examination. Fortunately, radiological exams have improved the preoperative diagnosis of these patients. However, in difficult cases when an underlying surgical disease is suspected, laparoscopy remains the gold standard in order to diagnose and treat if possible the suspected disorder. We present a case of acute left-side appendicitis in a child with unknown congenital intestinal malrotation. In addition, this case stressed the value of laparoscopy in daily practice to evaluate patients with atypical abdominal pain.