Bridging frontiers: The role of a Global Breast Research Working Group.

Breast cancer remains a significant cause of death for women globally, despite advancements in detection and treatment, low- and middle-income countries face unique obstacles. Role of Research Working Group (RWG) can expedite research progress by fostering collaboration between scientists, clinicians, and stakeholders. Benefits of a Global RWG include pooling resources and expertise to develop new research ideas, addressing disparities, and building local research capacity, with the potential to improve breast cancer research and outcomes.

Surgical research in Colombia part 3: Authorship and publications of Colombian medical students in surgery in Colombian medical journals-cross-sectional study.

Research training, scientific activity and publications are cornerstones of academic surgery. Knowing the activity and trends of medical students aspiring to become surgeons it allows to identify gaps and skills to be strengthened. Currently, there is no data on the authorship and scientific activity of medical students in surgery in Latin America and Colombia. Methods: A bibliometric cross-sectional study was carried out, in which the Colombian medical journals were reviewed from 2010 to 2020. The articles with topics in general surgery and subspecialties where the authorship of medical students could be identified, were selected. Data on the sociodemographic and scientific characteristics of the authors and their publications were extracted and analyzed. Results: A total of 14 383 articles from 34 Colombian medical journals were reviewed. From 2010 to 2020, 807 articles related to surgery were published in Colombia. The most frequent typology of these articles was original articles (n=298; 37%), followed by case reports (n=222; 28.2%) and reviews (n=137; 17.3%). A total of 132 medical students and 141 authorships and were found, specifically in 9.9% (n=80/807) of these publications, with a higher frequency in original articles (n=32; 40%) and case reports (n=29; 36.2%). Collaboration of students with professors or surgeons was evidenced in 97.5% of the publications. Conclusions: The authorship of Colombian medical students in scientific publications in surgery in Colombian medical journals was low. From 2010 to 2020, student authors were found in 1 out of every 10 publications, mainly in original articles and clinical cases.

Corrigendum.

[This corrects the article DOI: 10.1002/ccr3.5873.].

Diaphragmatic Dynamics and Thickness Parameters Assessed by Ultrasonography Predict Extubation Success in Critically Ill Patients.

INTRODUCTION: A frequent cause of weaning and extubation failure in critically ill mechanically ventilated patients is diaphragm muscle dysfunction. Ultrasound (US) evaluation of the diaphragm yields important data regarding its thickness (diaphragm thickening fraction [TFdi]) and its movement or excursion (diaphragmatic dynamics) that reveal the presence of diaphragmatic dysfunction. METHODS: Cross-sectional study, which included patients older than 18 years with invasive mechanical ventilation with an expected duration of more than 48 h, in a tertiary referral center in Colombia. The excursion of the diaphragm, inspiratory and expiratory thickness, and TFdi were evaluated by US. Prevalence and use of medications were evaluated, and the association with failure in ventilatory weaning and extubation was analyzed. RESULTS: Sixty-one patients were included. The median age and APACHE IV score were 62.42 years and 78.23, respectively. The prevalence of diaphragmatic dysfunction (assessed by excursion and TFdi) was 40.98%. The sensibility, specificity, positive predictive value, and negative predictive value for TFdi < 20% was 86%, 24%, 75%, and 40%, respectively, with an area under the receiver operating characteristic (ROC) curve of 0.6. The ultrasonographic analysis of excursion of the diaphragm, inspiratory and expiratory thickness, and TFdi (>20%) allow in its set and with normal values, predict success or failure for the extubation with an area under the ROC curve of 0.87. CONCLUSION: Diaphragmatic dynamics and thickness parameters together assessed by ultrasonography could predict the success of extubation in critically ill patients in Colombia, based on the finding of diaphragmatic dysfunction.

Translation, adaptation, and validation of the MeNTS score in colombian population: The MeNTS Col score.

Objective: To evaluate and validate the medically necessary and time sensitive score by testing the variables, in order to create a surgical preoperative score for procedure prioritization in COVID-19 pandemic in Colombia. Methods: A multicenter retrospective cross-sectional study of instrument validation with a cultural adaptation and translation into the Spanish language was carried out in Bogota, Colombia. Patients over 18 years of age who had undergone elective procedures of general surgery and subspecialties were included. The translation of the medically necessary and time sensitive score into Spanish was performed independently by two bilingual surgeons fluent in both English and Spanish. A final version of the Spanish questionnaire (MeNTS Col) for testing was then produced by an expert committee. After translation and cultural adaptation, it was submitted to evaluate the psychometric properties of the medically necessary and time sensitive score. Cronbach's α was used to represent and evaluate the internal consistency and assess reliability. Results: A total of 172 patients were included, with a median age of 54 years; of which 96 (55.8%) patients were females. The vast majority of patients were treated for general surgery (n = 60) and colon and rectal surgery (n = 31). The evaluation of the internal consistency of the scale items in Spanish version was measured, and values of 0.5 for 0.8 were obtained. In the reliability and validation process, Cronbach's α values in all items remained higher than 0.7. The new MeNTS Col model was analyzed, and a result of 0.91 was obtained. Conclusions: The Spanish version of the medically necessary and time sensitive, the MeNTS Col score, and its respective Spanish translation perform similarly to the original version. Therefore, they can be useful and reproducible in Latin American countries.

Surgical outcomes and factors associated with postoperative complications of colorectal cancer in a Colombian Caribbean population: Results from a regional referral hospital.

INTRODUCTION: Colorectal cancer is the most common malignant neoplasm of the gastrointestinal tract. Its incidence and mortality vary markedly at a global level. Assessing the epidemiological behavior of this condition allows reevaluating diagnostic, therapeutic and prognostic options, based on new findings. In Colombia, few studies have correlated variables associated with surgical and oncological outcomes in this type of cancer. Then, the aim of this study was to evaluate the surgical outcomes and factors associated with postoperative complications of colorectal cancer in a Colombian Caribbean Population. METHODS: Retrospective cross-sectional study, including patients with a histopathological diagnosis of colorectal cancer who underwent open or laparoscopic surgery, during a period of two years (2018-2020), from a regional referral hospital. Clinical history variables were collected. Frequencies and prevalence ratios were calculated. RESULTS: A total of 84 patients were finally included. Adenocarcinoma of non-special type with advanced clinical stages was the most prevalent (72.6%). Rectal neoplasia (45.2%) was the most frequent anatomical subsite, followed by proximal colon (p = 0.026). The anatomical subsite of the neoplasm, intraoperative complication (PR 1.38; 95% CI, 1.21-1.59, p = 0.001) and intensive care stay (PR 1.062; 95% CI, 1.01-1.12, p = 0.048) were associated with postoperative outcome. CONCLUSIONS: The anatomical subsite of the neoplasm location, the presence of intraoperative complications and the stay in intensive care may be associated with the surgical and oncological outcome of individuals with colon cancer from the Colombian Caribbean region.

Inotropic support in cardiogenic shock: who leads the battle, milrinone or dobutamine?

Cardiovascular diseases remain the leading cause of death globally, with acute myocardial infarction being one of the most frequent. One of the complications that can occur after a myocardial infarction is cardiogenic shock. At present, the evidence on the use of inotropic agents for the management of this complication is scarce, and only a few trials have evaluated the efficacy-adverse effects relationship of some agents. Milrinone and Dobutamine are some of the most frequently mentioned drugs that have been studied recently. However, there are still no data that affirm with certainty the supremacy of one over the other. The aim of this review is to synthesize evidence on basic and practical aspects of these agents, allowing us to conclude which might be more useful in current clinical practice, based on the emerging literature.

Surgical research in Colombia part 2: Scientific production of Colombian academic surgeons.

Introduction: The production of quality surgical evidence and the development of academic surgery have emerged as priorities for the solution of current barriers to achieving the objectives of global surgery. The academic training and scientific production of academic surgeons is essential for the production of new knowledge. In Latin America, specifically in Colombia, there are no studies that have analyzed this production. Methods: A retrospective cross-sectional bibliometric study was carried out, in which the Colombian Ministry of Science database was consulted with the validated results up to July 2021. In the search section for research profiles, the key word "Surgery" was used, and all associated CvLAC (profiles where the information of Colombian researchers can be found) and their registered products were reviewed. Results: A total of 1701 researchers in surgery were registered in the database of the Colombian Ministry of Science, of which only 380 corresponded to academic surgeons with correct registration. Only 6 (1.6%) were found to have a Ph.D., 45 (11.8%) a fellow, and 20 (5.3%) a master's degree. 79.5% (n = 302) of Colombian academic surgeons are men. Only 10.2% (n = 39) are formally categorized as researchers. 45.3% (n = 172) have not published scientific articles. The total number of published articles was 2386, and most of them were published in Q4 journals (n = 1121; 47%) or not indexed by SJR/Publindex (n = 517; 21.6%). Only 3 surgeons have more than 100 articles. 9.5% have published at least 1 book, and 40% have participated in at least 1 project. Conclusions: According to data registered with the Colombian Ministry of Science, a large part of the scientific production of Colombian academic surgeons is concentrated in scientific articles, most of which are found in Q4 or non-categorized journals. Approximately half of the academic surgeons have not published at least one scientific article. However, one fifth of those who have, have published at least 8 articles. Less than 20% of surgeons have additional postgraduate studies, and only 1 in 4 academic surgeons is a woman.

Perception of Physicians Working in Chile Toward Assisted Suicide and Euthanasia: A Nationwide Cross-Sectional Study.

INTRODUCTION: Assisted suicide and euthanasia are controversial issues today and have been throughout the history of humanity, mainly because there are individuals for and against them. Currently, the legalization of these practices is being discussed in Chile, and the perception of physicians regarding this issue is unknown. Therefore, this study aimed to assess physicians' perception of Chile's euthanasia and assisted suicide. METHODS: A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians' attitudes and opinions on assisted suicide and euthanasia was used. The population was the doctors who work in Chile, and the sample was convenient with a sample calculation of 384 physicians. About 20 variables were considered and included in a form created through the Google forms option, which was distributed through social networks: LinkedIn, Facebook, Twitter, and WhatsApp. To guarantee the anonymity of the participants, the option to request and remember the participant's email was deactivated. A generated database allowed the quantitative analysis of the variables and their expression through frequencies, percentages, and graphs. The European University of the Atlantic's research ethics committee approved this study as stated in the document CE-55 of March 2021. RESULTS: A total of 410 physicians were surveyed. 50.7% (n = 208) of the participants identified themselves as men, and 69.8% (n = 286) were Chilean. The city of Santiago was the area of residence of 72.9% (n = 299) of the participants. About 34.6% (n = 142) of participants were general practitioners, and 39.3% (n = 161) of the physicians had more than 20 years of experience. About 68.7% had favorable attitudes toward euthanasia and 54.4% toward assisted suicide; However, although the majority favored legalizing euthanasia and assisted suicide, approximately 48.8% stated that they would not participate in an assisted suicide procedure. CONCLUSIONS: There was evidence of support for the implementation and legalization of euthanasia and assisted suicide by physicians in Chile. However, there are still professionals who have not yet decided on a definitive position on these practices.

First case report of gastric outlet obstruction due to aortofemoral bypass Dacron graft erosion of the duodenum treated with neo aortoiliac system procedure.

INTRODUCTION: Gastric outlet obstruction is an uncommon complication of surgical treatment of aortoiliac occlusive disease with aortofemoral bypass. The most frequent presenting feature of duodenal erosion due to aortic synthetic graft is upper gastrointestinal bleeding, which can range from a minor "herald" bleed to exsanguinating hemorrhage. CASE PRESENTATION: A 64-year-old male patient with an aortofemoral Dacron bypass due to aortoiliac occlusive disease TASC II D with a chronic graft infection required emergency resection of the right limb of the Dacron graft two years ago. The patient developed abdominal pain, postprandial vomiting and progressive weight loss with an upper gastrointestinal endoscopy that showed Dacron graft material eroding into the fourth portion of the duodenum generating a gastric outlet obstruction without aortoenteric fistula and ulceration in the duodenal mucosa. CLINICAL DISCUSSION: The treatment goals of aortoenteric fistula are to control hemorrhage, treat infection, maintain adequate distal perfusion, graft explantation and aortic reconstructions like in this case. Traditional treatment of aortoenteric fistula is graft excision and establishing an anatomic autologous or an extra-anatomic synthetic bypass. Neo aortoiliac system procedure has shown to be the most effective and safest emerging technique today. CONCLUSION: Aortoenteric fistula is a life-threatening condition associated with high morbidity and mortality and it can also pose a diagnostic dilemma. There are many presentations of aortoenteric fistula including gastric outlet obstruction syndrome. The neo aortoiliac system procedure is the ideal curative surgical approach in stable patients.

Pre-operative factors associated with short- and long-term outcomes in the patient with inguinal hernia: What does the current evidence say?

Hernia repair is one of the most frequent interventions in surgery worldwide. The approach to abdominal wall and inguinal hernias remains a challenge due to emerging evidence on aspects such as timely diagnosis, use of innovative techniques or post-surgical care. However, pre-operative preparation is also a factor that substantially affects the absolute success rate of this type of condition. Time management between diagnosis and intervention, control of diseases that increase intra-abdominal pressure, weight and nutritional status, are some of the many elements to be considered in this type of patients before surgery. Considering that this condition carries high health care costs, especially in case of recurrence, has a risk of complications and affects the individual's functional capacity, the objective of this review is to synthesize evidence on the role of these factors on the short- and long-term outcome of inguinal hernia management, and to make suggestions on the general approach to this type of patients.

Surgical research in Colombia part 1: Scientific and academic productivity of the Colombian research groups in surgery.

Introduction: Global surgery has become the undisputed starting point for addressing a myriad of problems in surgery today. Therefore, it is necessary to constantly evaluate the scientific productivity in surgery, its behavior, validity and impact. In Latin America, specifically in Colombia, there are no studies that have analyzed this production. Methods: A retrospective cross-sectional bibliometric study was carried out, in which the Colombian Ministry of Science database was consulted with the validated results up to July 2021. In the search section for research groups, the key word "Surgery" was used, and all associated GrupLAC (platform where the information of the research groups can be found) and their registered products were reviewed. Results: 40 groups were included. Only 5 (12.5%) were registered in surgery as main line of research. The great majority of the groups were in the medium-low category, 50% in category C and 22.5% in category B. The vast majority of surgical groups are located in Bogotá (19; 47.5%). The first surgery group in the country was created in 1994 and the last one in 2017. In 27 years of surgical research, a total of 4121 registered scientific articles were found, 83 books, 713 book chapters, 2891 products associated with participation in scientific events, 1221 theses directed, and 1670 projects in colombian surgical research groups. There was evidence of a high rate of underreporting of data, due to duplication of products and incomplete registration of data. Conclusions: There is a high rate of underreporting of products and data in the GrupLAC of Colombian surgical research groups. Most of the production is located in the Andes region (Antioquia, Valle del Cauca and Bogotá), and is predominantly composed of scientific articles and products associated with participation in scientific events.

Indocyanine green fluorescence: A surgeon's tool for the surgical approach of gallstone ileus.

Fluorescence cholangiography has been shown to improve biliary anatomy identification. A case of 60-year-old man with intestinal obstruction is reported, an entero-biliary fistula is suspected, and intravenous application of indocyanine green is decided, despite the great inflammatory process and fibrotic tissues found during the procedure, safe open cholecystectomy was achieved.

Intraoperative finding of papyraceous twin fetus in pregnant woman without specialized follow-up: A summary of difficulties in accessing prenatal services in low- and middle-income countries.

INTRODUCTION AND IMPORTANCE: The papyraceous fetus is the product of the intrauterine fetal death of a twin in early pregnancy, with retention of the fetus for a minimum of 10 weeks, resulting in mechanical compression of the small fetus. It is a finding that can be found early by ultrasound to avoid increased obstetric risk, but in low- to middle-income countries it is not always available. CASE PRESENTATION: We present the case of a 22-year-old multipara patient was remitted to the emergency department due to a one-hour history of premature rupture of the membranes. Only one control ultrasound was performed at 25 weeks of pregnancy. Cesarean section was performed and two products were found, one of them a papyraceous fetus. CLINICAL DISCUSSION: Almost 50% of women in low- and middle-income countries don't receive adequate antenatal care. It has been estimated that up to half of twins and almost all triplets are born premature and have a higher risk of dying compared to those born at term; specifically, this risk is much higher if the pregnancy is accompanied by rare pathological conditions. CONCLUSION: The papyraceous fetus is a rare condition that represents a risk to the health of the mother and other babies, in case of multiple pregnancy; but it can be diagnosed early through imaging studies. Socio-cultural, socio-economic and direct difficulties of the health system may be the cause of the delay in the diagnosis of this pathological entity, making it an unexpected finding during delivery or intraoperatively.

Cystic adventitial disease of popliteal artery, the both sides of the coin: Arterial resection vs cyst excision.

Adventitial cystic disease (ACD) is a rare form of non-atherosclerotic arterial stenosis. This entity accounts only for 0.1% of all vascular diseases and affects the popliteal artery unilaterally in 85% of the cases. The options for treatment ACD include excision of cysts, removal of the affected arterial segment with vein graft reconstruction or radiological aspiration. We present two cases of ACD of the popliteal artery and its subsequent management and discuss the pros and cons of the treatment's strategies.

Impact of helminthiasis on gestational anemia in low- and middle-income countries: a systematic review and meta-analysis of more than 19,000 women.

Intestinal helminthiasis are a common public health problem in developed and developing countries. It is thought that they can influence pregnancy by causing gestational anemia. The aim of this study was to determine if there is a relationship between helminth infection and gestational anemia. A structured review of scientific literature was conducted through active search in the electronic databases MEDLINE® and LILACS® until December 2021, following 2020 PRISMA statement. The studies were reviewed independently by two authors, extracting the most relevant information from each study. Cross-sectional studies, case-control and ecological studies were included, with no date or language limit. Randomized clinical trials were excluded. A total of 38 studies were included in the systematic review. The study populations of all studies belonged to low- and middle-income countries: 28 studies from Africa, 6 from Asia, 3 from Latin America and 1 from Oceania. Overall, the average prevalence of gestational anemia among the included studies was 40% (95% CI 34-46%). Hookworm was the predominant species detected in most studies (19/38; 50%), followed by Ascaris lumbricoides (15/38; 39.5%). Gestational anemia was positively associated with A. lumbricoides (OR 1.86, 95% CI 1.12-3.08) and hookworms (OR 3.09, 95% CI 1.99-4.78). Prevalence of malaria was not associated with the magnitude of the effect of hookworm on anemia risk during meta-regression (p=0.5182). The results of this review indicate that there is a statistically significant association between helminthiasis and gestational anemia. Although hookworm is the main species associated with the outcome, prevalence of malaria was not associated with the magnitude of the effect of hookworm on anemia risk. The impact of other species needs to be defined given the expected bias that arises from polyparasitism when defining comparison groups.