Estudio exploratorio de un taller basado en el Protocolo Unificado para el manejo de ansiedad ante exámenes.

Introducción: La ansiedad ante exámenes es un constructo multidimensional, caracterizado por respuestas fenomenológicas, fisiológicas, conductuales y cognitivas asociadas a una preocupación excesiva sobre posibles consecuencias negativas ante una situación evaluativa. En estudiantes universitarios, presenta tasas de  ocurrencia entre 10 % y 40 %. El objetivo es evaluar la utilidad de un taller grupal y online para el manejo de esta problemática, basado en el Protocolo Unificado. Método: Participaron 31 estudiantes argentinos con edades de 18 a 35 años (M=25; DE= 5,24), siendo el 93.5 % mujeres. Se evaluó medidas pre, post y seguimiento en sintomatología asociada a la ansiedad ante exámenes (GTAI-AR) como variable primaria, y estrategias de regulación emocional (ERQ) y conciencia plena (MAAS) como variables secundarias. Para corroborar diferencias intra grupo se calculó la prueba de Wilcoxon, y como medida de tamaño del efecto (TE), la g de Hedges. Resultados: En cuanto a la variable primaria entre las tres medidas aplicadas, las diferencias fueron significativas con TE moderados y grandes. En las variables secundarias, solo la  reevaluación cognitiva reflejó TE considerables (pequeños) en el pre-post; en el post-seguimiento la supresión expresiva fue la única dimensión que reflejó TE significativos (moderados); y en el pre-seguimiento, únicamente la conciencia plena arrojó TE relevantes (pequeños). Discusión: Los resultados son coherentes con el marco del Protocolo Unificado y las investigaciones actuales sobre su aplicación. Conclusiones: Se espera que estos resultados sean útiles para el diseño de intervenciones similares. Si bien éstos fueron alentadores, se requieren investigaciones de mayor rigurosidad que permitan estudiar su eficacia.

Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis.

BACKGROUND: Robotic colorectal surgery is becoming the preferred surgical approach for colorectal cancer (CRC). It offers several technical advantages over conventional laparoscopy that could improve patient outcomes. In this retrospective cohort study, we compared robotic and laparoscopic surgery for CRC using a national cohort of patients. METHODS: Using the colectomy-targeted ACS-NSQIP database (2015-2020), colorectal procedures for malignant etiologies were identified by CPT codes for right colectomy (RC), left colectomy (LC), and low anterior resection (LAR). Optimal pair matching was performed. "Textbook outcome" was defined as the absence of 30-day complications, readmission, or mortality and a length of stay < 5 days. RESULTS: We included 53,209 out of 139,759 patients screened for eligibility. Laparoscopic-to-robotic matching of 2:1 was performed for RC and LC, and 1:1 for LAR. The largest standardized mean difference was 0.048 after matching. Robotic surgery was associated with an increased rate of textbook outcomes compared to laparoscopy in RC and LC, but not in LAR (71% vs. 64% in RC, 75% vs. 68% in LC; p < 0.001). Robotic LAR was associated with increased major morbidity (7.1% vs. 5.8%; p = 0.012). For all three procedures, the mean conversion rate of robotic surgery was lower than laparoscopy (4.3% vs. 9.2%; p < 0.001), while the mean operative time was higher for robotic (225 min vs. 177 min; p < 0.001). CONCLUSIONS: Robotic surgery for CRC offers an advantage over conventional laparoscopy by improving textbook outcomes in RC and LC. This advantage was not found in robotic LAR, which also showed an increased risk of serious complications. The associations highlighted in our study should be considered in the discussion of the surgical management of patients with colorectal cancer.

Honduras: two hurricanes, COVID-19, dengue and the need for a new digital health surveillance system.

A recently published article of this journal stated that informatics solutions can guide better public health decision-making during the COVID 19 (Coronavirus Disease 2019) pandemic. Honduras is a country facing the COVID-19 pandemic with a weak health surveillance system while also fighting a dengue epidemic and the aftermath of two hurricanes that struck its territory in November 2020. In response, we as academics started a COVID-19 and Dengue Observatory combining several technological platforms and developing multidisciplinary research to help the country navigate the crisis. Mapping the pandemic and the natural disasters showed us that technology can be applied toward epidemiology to benefit communities in a time of need by quickly building a basic digital health surveillance system for Honduras.

Ileocecal Anastomosis Type Significantly Influences Long-Term Functional Status, Quality of Life, and Healthcare Utilization in Postoperative Crohn's Disease Patients Independent of Inflammation Recurrence.

OBJECTIVES: Anastomotic reconstruction following intestinal resection in Crohn's disease (CD) may employ side-to-side anastomosis (STSA; anti-peristaltic orientation) or end-to-end anastomosis (ETEA). Our aim was to determine the impact of these two anastomotic techniques on long-term clinical status in postoperative CD patients. METHODS: We performed a comparative effectiveness study of prospectively collected observational data from consented CD patients undergoing their first or second ileocolonic bowel resection and re-anastomosis between 2008 and 2012, in order to assess the association between anastomosis type and 2-year postoperative quality of life (QoL), healthcare utilization, disease clinical or endoscopic recurrence, use of medications, and need for repeat resection. RESULTS: One hundred and twenty eight postoperative CD patients (60 STSA and 68 ETEA) were evaluated. At 2 years postoperatively, STSA patients had higher rates of emergency department visits (33.3% vs. 14.7%; P=0.01), hospitalizations (30% vs. 11.8%; P=0.01), and abdominal computed tomography scans (50% vs. 13.2%; P<0.001) with lower QoL (mean short inflammatory bowel disease questionnaire 47.9 vs. 53.4; P=0.007). There was no difference among the two groups in the 30 day surgical complications and 2-year patterns of disease activity, CD medication requirement, endoscopic recurrence, and need for new surgical management (all P > 0.05). CONCLUSIONS: At 2 years postoperatively, CD patients with ETEA demonstrated better QoL and less healthcare utilization compared with STSA, despite having similar patterns of disease recurrence and CD treatment. These findings suggest that surgical reconstruction of the bowel as an intact tube (ETEA) contribute to improved functional and clinical status in patients with CD.

High-resolution scanning tunneling microscope and its adaptation for local thermopower measurements in 2D materials.

We present the design, fabrication and discuss the performance of a new combined high-resolution Scanning Tunneling and Thermopower Microscope (STM/SThEM). We also describe the development of the electronic control, the user interface, the vacuum system, and arrangements to reduce acoustical noise and vibrations. We demonstrate the microscope's performance with atomic-resolution topographic images of highly oriented pyrolytic graphite (HOPG) and local thermopower measurements in the semimetal Bi2Te3. Our system offers a tool to investigate the relationship between electronic structure and thermoelectric properties at the nanoscale.

"Peek port": a novel approach for avoiding conversion in laparoscopic colectomy.

BACKGROUND: This study aimed to assess the efficacy of a method for avoiding conversion to laparotomy in patients considered for laparoscopic colectomy. Patients deemed to be at high risk for conversion to laparotomy were initially approached via an 8-cm midline incision ("peek port") with the laparoscopic equipment unopened. If intraperitoneal conditions were favorable, the procedure was performed using hand-assisted laparoscopy. If intraperitoneal conditions were unfavorable, the incision was extended to a formal laparotomy. Patients deemed to be at low risk for conversion to laparotomy were approached laparoscopically from the outset. METHODS: Data from 241 consecutive patients brought to the operating room for intended laparoscopic colectomy were retrieved from a prospective database. RESULTS: The study population consisted of 132 men and 109 women with a mean age of 62 years and a mean body mass index (BMI) of 28. Prior abdominal surgery had been performed in 49% of these patients. Inflammatory conditions accounted for 38% of the diagnoses, and enteric fistulas were present in 7% of the cases. Of the 25 patients who underwent the initial "peek port," 8 (32%) underwent immediate incision extension to formal laparotomy. Hand-assisted laparoscopic colectomy was performed in 17 (68%) of these 25 patients, with one subsequent conversion to formal laparotomy. Of the 216 patients initially approached laparoscopically, 5 (2%) required conversion to laparotomy. The laparotomy rate for the "peek port" group (9/25, 36%) was higher than for the initial laparoscopy group (5/216, 2%) (p < 0.0001). Of the 233 patients from both groups who underwent laparoscopy, the overall rate for conversion to laparotomy was 3% (6/233). CONCLUSIONS: The "peek port" approach to the patient with a potentially hostile abdomen allows for rapid assessment of intraperitoneal conditions and is associated with an overall low rate of conversion from laparoscopy to laparotomy. This technique should reduce overall cost by avoiding the use of laparoscopic equipment as well as potential complications related to trocar placement and laparoscopic dissection in patients who will ultimately require formal laparotomy.

Technical skills assessment as part of the selection process for a fellowship in minimally invasive surgery.

INTRODUCTION: Selection of candidates for surgical fellowships has traditionally been based on subjective evaluations by the program directors and references from previous positions. The introduction of well-validated objective methods of assessment has allowed us to evaluate candidates' technical skills and base the selection process on objective, reliable, and transparent criteria. The aim of the study was to assess the applicability of such methods in current practice. MATERIALS AND METHODS: Prospective study. Eight surgeons, applying for a fellowship position in minimally invasive surgery (MIS), performed a previously validated assessment curriculum using a Virtual-Reality Laparoscopic Trainer (LapSim 3.0, Surgical Science, Gothenburgh, Sweden). Technical performance was evaluated using criteria registered by the simulator, i.e., time, error score, and efficiency of movements score. Candidates performed all the tasks in easy end medium level until reaching predefined criteria. If proficiency criteria were not achieved on easy or medium level after nine repetitions the test was considered as failed. Additionally, all applicants underwent an interview by two independent attending surgeons. Each applicant received a grade on a ten-point scale. RESULTS: Five out of the eight candidates failed the technical skills assessment test. One candidate failed to achieve proficiency criteria on easy level, one on medium, and three on difficult level. Evaluation scores, based on the interview of the candidates showed a good interrater reliability (Cronbach's alpha = 0.8). There was no significant correlation between the interviewers rating, and the applicants technical skills demonstrated during the test on the VR trainer (Spearman's rho = 0.182, p = 0.696). CONCLUSIONS: Evaluations by senior surgeons are reproducible and reliable. The introduction of technical skills assessment has the potential to improve the current method of candidate selection, making it more valid, objective, and transparent.

Laparoscopic colectomy for apparently benign colorectal neoplasia: A word of caution.

PURPOSE: Endoscopically unresectable apparently benign colorectal polyps are considered by some surgeons as ideal for their early laparoscopic colectomy experience. Our hypotheses were: (1) a substantial fraction of patients undergoing laparoscopic colectomy for apparently benign colorectal neoplasia will have adenocarcinoma on final pathology; and (2) in our practice, we perform an adequate laparoscopic oncological resection for apparently benign polyps as evidenced by margin status and nodal retrieval. METHODS: Data from a consecutive series of patients undergoing laparoscopic colectomy (on an intention-to-treat basis) for endoscopically unresectable neoplasms with benign preoperative histology were retrieved from a prospective database and supplemented by chart review. RESULTS: The study population consisted of 63 patients (mean age 67, mean body mass index 29). Two out of 63 cases (3%) were converted to laparotomy because of extensive adhesions (n = 1) and equipment failure (n = 1). Colectomy type: right/transverse (n = 49, 78%); left/anterior resection (n = 10, 16%); subtotal (n = 4, 6%). Invasive adenocarcinoma was found on histological analysis of the colectomy specimen in 14 out of 63 cases (22%), standard error of the proportion 0.052. Staging of the 14 cancers were I (n = 6, 43%), II (n = 3, 21%), III ( = 4, 29%), and IV (n = 1, 7%). The median nodal harvest was 12 and all resection margins were free of neoplasm. Neither dysplasia on endoscopic biopsy nor lesion diameter was predictive of adenocarcinoma. Eight out of 23 (35%) patients with dysplasia on endoscopic biopsy had adenocarcinoma on final pathology versus 6/40 (15%) with no dysplasia (p = 0.114, Fisher's exact test). Mean diameter of benign tumors was 3.2 cm (range 0.5-10.0cm) versus 3.9cm (range 1.5-7.5cm) for adenocarcinomas (p = 0.189, t - test). CONCLUSION: A substantial fraction of endoscopically unresectable colorectal neoplasms with benign histology on initial biopsy will harbor invasive adenocarcinoma, some of advanced stage. This finding supports the practice of performing oncological resection for all patients with endoscopically unresectable neoplasms of the colorectum. The inexperienced laparoscopic colectomist should approach these cases with caution.

Prevalence of Helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Previous studies have reported a high prevalence of Helicobacter pylori infection in patients undergoing Roux-en-Y gastric bypass (RYGB) and a greater incidence of anastomotic ulcer in patients positive for H. pylori, leading to recommendations for routine preoperative screening. Our hypotheses were that the prevalence of H. pylori in patients undergoing RYGB is similar to that of the general population and that preoperative H. pylori testing and treatment does not decrease the incidence of anastomotic ulcer or pouch gastritis. METHODS: A retrospective analysis of H. pylori serology, preoperative and postoperative endoscopy findings, and the development of anastomotic ulcer or erosive pouch gastritis was performed. All patients positive for H. pylori received treatment. Univariate parametric and nonparametric statistical tests, as well as multiple logistic regression analyses, were performed. RESULTS: A total of 422 LRYGB patients were included in the study. Of these patients, 259 (61.4%) were tested for H. pylori and 163 (38.6%) were not. Of the 259 patients, 58 (22.4%) tested positive for H. pylori, 197 (76.1%) tested negative, and 4 (1.5%) had an equivocal result. Postoperatively, 53 patients (12.6%) underwent upper endoscopy. Of these 53 patients, 19 (4.5%) had positive endoscopy findings for anastomotic ulcer (n = 16) or erosive pouch gastritis (n = 3). Five patients underwent biopsy at endoscopy; all biopsies were negative for H. pylori. No difference was found in the rate of positive endoscopy between patients tested preoperatively for H. pylori (5%) and patients not tested (3.7%). CONCLUSION: The results of our study have shown that the prevalence of H. pylori infection in patients undergoing RYGB is similar to that of the general population. Our study has shown that H. pylori testing does not lower the risk of anastomotic ulcer or pouch gastritis.

Obesity Does Not Impact Perioperative or Postoperative Outcomes in Patients with Inflammatory Bowel Disease.

BACKGROUND: While the prevalence of obesity in IBD patients is rapidly increasing, it is unclear if obesity impacts surgical outcomes in this population. We aim to investigate the effects of BMI on perioperative and postoperative outcomes in IBD patients by stratifying patients into BMI groups and comparing outcomes between these groups. METHODS: This is a retrospective cohort study where IBD patients who underwent intestinal surgeries between the years of 2000 to 2014 were identified. The patients were divided into groups based on BMI: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obese (BMI ≥30). Preoperative patient demographics, operative variables, and postoperative complications were collected and compared between BMI groups. RESULTS: A total of 391 surgeries were reviewed (34 underweight, 187 normal weight, 105 overweight, and 65 obese) from 325 patients. No differences were observed in preoperative patient demographics, type of IBD, preoperative steroid or biologic mediator use, or mean laboratory values. No differences were observed in percent operative procedures with anastomosis, surgeries converted to open, estimated blood loss, intraoperative complications, and median operative time. Thirty-day postoperative complication rates including total complications, wound infection, or anastomotic leak were similar between groups. There was a statistically significant increased postoperative bleeding risk (p = 0.029) in underweight patients. The relative percent for increased postoperative bleeding risk between BMI groups was as follows: 2.9% in underweight, zero in normal weight, 2.9% in overweight, and zero in obese. CONCLUSION: Obesity does not appear to impact intraoperative variables nor does obesity appear to worsen postoperative complication rates in IBD patients.

Risk factors for the development of an incisional hernia after sigmoid resection for diverticulitis: an analysis of 33 patients, operative and disease-associated factors.

Incisional hernia (IH) is a relatively common sequelae of sigmoidectomy for diverticulitis. The aim of this study was to investigate factors that may predict IH in diverticulitis patients. Two hundred and one diverticulitis patients undergoing sigmoidectomy between January 2002 and December 2012 were identified (mean follow-up 5.15 ± 2.33 years). Patients with wound infections were excluded. Thirteen patient-associated, three diverticular disease-related, and 17 operative variables were evaluated in patients with and without IH. Volumetric fat was measured on preoperative CTs. Fischer's exact, χ(2), and Mann-Whitney tests and multivariate regression analysis were used for statistics. Thirty-four (17%) patients had an IH. On multivariate analysis, wound packing (OR 3.4, P = 0.017), postoperative nonwound infection (OR 7.4, P = 0.014), and previous hernia (OR 3.6, P = 0.005) were as independent predictors of IH. Fifteen of 34 (44%) patients who developed a hernia had a history of prior hernia. Of 33 potential risk factors analyzed, including smoking, chronic obstructive pulmonary disease, and obesity, the only patient factor present preoperatively associated with increased risk of a postsigmoidectomy hernia after multivariate analysis was a history of a previous hernia. Preoperative identification of patients with a history of hernia offers the opportunity to employ measures to decrease the likelihood of IH.

Importancia de medir función tiroidea en pacientes con trastornos del ánimo / The importance of measuring thyroid function in mood disorder patients

El hipotiroidismo (HT) es una patología producida por la disminución de hormonas tiroideas. Se manifiesta con una serie de síntomas que pueden llegar a confundirse con trastornos del ánimo. La comprensión de sus mecanismos fisiopatológicos permite establecer una relación con la génesis de estas manifestaciones. Cuando las alteraciones son sutiles, sólo se podrá diagnosticar por medio de pruebas de laboratorio; relevantes cuando hablamos de hipotiroidismo subclínico (HS), donde se encuentran niveles de TSH elevado con T4 libre y T3 normales. En esta revisión se analiza la importancia de medir niveles plasmáticos de hormonas tiroideas para el diagnóstico diferencial en pacientes con trastorno del ánimo, debido a que el HS puede enmascarar o asociarse a una depresión, enfatizando además en lo prevalente de ambas patologías.

Hypothyroidism is a pathology caused by diminished production of thyroid hormones. It causes a series of symptoms which may be confused with mood disorders. Understanding its pathophysiological mechanisms allows one to see how these symptoms are generated. When the signs are subtle, only laboratory tests can diagnose the disease; this is especially relevant in the case of sub-clinical hypothyroidism where TSH levels are raised and free T4 and T3 are normal. In this review we analyze the importance of measuring plasmatic levels of thyroid hormones in mood disorder patients for the differential diagnosis, as hypothyroidism can mask or associate itself with depression, while emphasizing the prevalence of both pathologies.

Alien plant monitoring with ultralight airborne imaging spectroscopy.

Effective management of invasive plants requires a precise determination of their distribution. Remote sensing techniques constitute a promising alternative to field surveys and hyperspectral sensors (also known as imaging spectrometers, with a large number of spectral bands and high spectral resolution) are especially suitable when very similar categories are to be distinguished (e.g. plant species). A main priority in the development of this technology is to lower its cost and simplify its use, so that its demonstrated aptitude for many environmental applications can be truly realized. With this aim, we have developed a system for hyperspectral imaging (200 spectral bands in the 380-1000 nm range and circa 3 nm spectral resolution) operated on board ultralight aircraft (namely a gyrocopter), which allows a drastic reduction of the running costs and operational complexity of image acquisition, and also increases the spatial resolution of the images (circa 5-8 pixels/m(2) at circa 65 km/h and 300 m height). The detection system proved useful for the species tested (Acacia melanoxylon, Oxalis pes-caprae, and Carpobrotus aff. edulis and acinaciformis), with user's and producer's accuracy always exceeding 90%. The detection accuracy reported corresponds to patches down to 0.125 m(2) (50% of pixels 0.5 × 0.5 m in size), a very small size for many plant species, making it very effective for initial stages of invasive plant spread. In addition, its low operating costs, similar to those of a 4WD ground vehicle, facilitate frequent image acquisition. Acquired images constitute a permanent record of the status of the study area, with great amount of information that can be analyzed in the future for other purposes, thus greatly facilitating the monitoring of natural areas at detailed spatial and temporal scales for improved management.

Volumetric electromagnetic phase-shift spectroscopy of brain edema and hematoma.

Motivated by the need of poor and rural Mexico, where the population has limited access to advanced medical technology and services, we have developed a new paradigm for medical diagnostic based on the technology of "Volumetric Electromagnetic Phase Shift Spectroscopy" (VEPS), as an inexpensive partial substitute to medical imaging. VEPS, can detect changes in tissue properties inside the body through non-contact, multi-frequency electromagnetic measurements from the exterior of the body, and thereby provide rapid and inexpensive diagnostics in a way that is amenable for use in economically disadvantaged parts of the world. We describe the technology and report results from a limited pilot study with 46 healthy volunteers and eight patients with CT radiology confirmed brain edema and brain hematoma. Data analysis with a non-parametric statistical Mann-Whitney U test, shows that in the frequency range of from 26 MHz to 39 MHz, VEPS can distinguish non-invasively and without contact, with a statistical significance of p<0.05, between healthy subjects and those with a medical conditions in the brain. In the frequency range of between 153 MHz to 166 MHz it can distinguish with a statistical significance of p<0.05 between subjects with brain edema and those with a hematoma in the brain. A classifier build from measurements in these two frequency ranges can provide instantaneous diagnostic of the medical condition of the brain of a patient, from a single set of measurements. While this is a small-scale pilot study, it illustrates the potential of VEPS to change the paradigm of medical diagnostic of brain injury through a VEPS classifier-based technology. Obviously substantially larger-scale studies are needed to verify and expand on the findings in this small pilot study.

Antifungal activity of the echinocandin anidulafungin (VER002, LY-303366) against yeast pathogens: a comparative study with M27-A microdilution method.

This study further evaluated the in vitro activity of anidulafungin (VER002, Versicor Inc.) (LY303366) against 460 clinical yeast isolates. MICs of anidulafungin, fluconazole and itraconazole were determined by following the NCCLS M27-A guidelines. Minimum fungicidal concentrations (MFCs) of anidulafungin were determined for 230 isolates of Candida spp. The activity of anidulafungin in vitro was significantly superior (P < 0.05) to those of itraconazole and fluconazole against Candida albicans, Candida tropicalis, Candida glabrata and Candida krusei, but anidulafungin was less active for Candida famata and Candida parapsilosis. The differences were not significant for the other species evaluated.

Rectosigmoidectomía perineal en el tratamiento del prolapso rectal completo / Perineal rectosigmoidectomy for the treatment of complete rectal prolapse

Antecentes: El tratamiento quirúrgico del prolapso rectal completo es controvertido. Se han descrito técnicas abdominales y perineales. La rectosigmoidectomía perineal (RSP) como tratamiento en el prolapso rectal completo. Lugar de aplicación: Hospital universitario. Diseño: retrospectivo, observacional. Población: 98 pacientes con prolapso rectal completo operados entre 1985 y 2005. Método: Análisis retrospectivo y descriptivo de los pacientes con prolapso rectal completo sometidos a una RSP en un Servicio de Coloproctología. Resultados: Se realizaron 106 cirugías en 98 pacientes (79 mujeres y 19 varones, edad promedio: 78 años). El seguimiento postoperatorio fue de 11 a 101 meses. El 72 por ciento presentaban incotinencia preoperatoria. En los primeros 30 pacientes la rectosigmoidectomía perineal se realizó sin la plástica del elevador, mientras que esta se utilizó en los siguientes, como parte del procedimiento. La incontinencia mejoró en el 43 por ciento y 84 por ciento respectivamente (P = 0,01). La estadía media intrahospitalaria fue de 3,5 días. La morbilidad postoperatoria fue del 14 por ciento: 3 hemorragias postoperatorias, 2 infecciones, 1 estenosis, 4 internaciones en UTI y 5 misceláneas. La mortalidad fue nula. El porcentaje de readmisión a los 30 días fue del 3 por ciento. La recidiva fue del 13,2 por ciento (n = 15). En 8 casos se repitió el procedimiento, en 2 resección/pexia y en 1 caso rectopexia con malla. Cuatro pacientes no se reoperaron. Conclusión: La RSP es un procedimiento seguro y efectivo en el tratamiento del prolapso rectal completo. La adición de una plástica del elevador al procedimiento mejora la incontinencia que suele presentarse en estos pacientes.