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Bacterial membrane lipids are critical for membrane bilayer formation, cell division, protein localization, stress responses, and pathogenesis. Despite their critical roles, membrane lipids have not been fully elucidated for many pathogens. Here, we report the discovery of a novel cationic glycolipid, lysyl-glucosyl-diacylglycerol (Lys-Glc-DAG), which is synthesized in high abundance by the bacterium Streptococcus agalactiae (Group B Streptococcus, GBS). To our knowledge, Lys-Glc-DAG is more positively charged than any other known lipids. Lys-Glc-DAG carries 2 positive net charges per molecule, distinct from the widely described lysylated phospholipid lysyl-phosphatidylglycerol (Lys-PG) that carries one positive net charge due to the presence of a negatively charged phosphate moiety. We use normal phase liquid chromatography (NPLC) coupled with electrospray ionization (ESI) high-resolution tandem mass spectrometry (HRMS/MS) and genetic approaches to determine that Lys-Glc-DAG is synthesized by the enzyme MprF in GBS, which covalently modifies the neutral glycolipid Glc-DAG with the cationic amino acid lysine. GBS is a leading cause of neonatal meningitis, which requires traversal of the endothelial blood-brain barrier (BBB). We demonstrate that GBS strains lacking mprF exhibit a significant decrease in the ability to invade BBB endothelial cells. Further, mice challenged with a GBSΔmprF mutant developed bacteremia comparably to wild-type (WT) infected mice yet had less recovered bacteria from brain tissue and a lower incidence of meningitis. Thus, our data suggest that Lys-Glc-DAG may contribute to bacterial uptake into host cells and disease progression. Importantly, our discovery provides a platform for further study of cationic lipids at the host-pathogen interface.
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Barrera Hematoencefálica/metabolismo , Encéfalo/metabolismo , Glucolípidos/metabolismo , Meningitis/metabolismo , Streptococcus agalactiae/metabolismo , Aminoaciltransferasas/genética , Aminoaciltransferasas/metabolismo , Animales , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Transporte Biológico/genética , Cationes/química , Cromatografía Liquida/métodos , Glucolípidos/química , Humanos , Masculino , Ratones , Mutación , Espectrometría de Masa por Ionización de Electrospray/métodos , Streptococcus agalactiae/genética , Espectrometría de Masas en Tándem/métodosRESUMEN
Bacterial infections are a major cause of morbidity and mortality worldwide and the rise of antibiotic resistance necessitates development of alternative treatments. Pathogen adhesins that bind to host cells initiate disease pathogenesis and represent potential therapeutic targets. We have shown previously that the BspC adhesin in Group B Streptococcus (GBS), the leading cause of bacterial neonatal meningitis, interacts with host vimentin to promote attachment to brain endothelium and disease development. Here we determined that the BspC variable (V-) domain contains the vimentin binding site and promotes GBS adherence to brain endothelium. Site directed mutagenesis identified a binding pocket necessary for GBS host cell interaction and development of meningitis. Using a virtual structure-based drug screen we identified compounds that targeted the V-domain binding pocket, which blocked GBS adherence and entry into the brain in vivo. These data indicate the utility of targeting the pathogen-host interface to develop anti-virulence therapeutics.
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Meningitis Bacterianas , Infecciones Estreptocócicas , Adhesinas Bacterianas/genética , Adhesinas Bacterianas/metabolismo , Humanos , Recién Nacido , Meningitis Bacterianas/metabolismo , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae , Vimentina/metabolismo , VirulenciaRESUMEN
BACKGROUND: RhD-negative blood products are in chronic short supply leading to renewed interest in utilizing RhD-positive blood products for emergency transfusions. This study assessed parental perceptions of emergency RhD-positive blood use in children. METHODS: A survey of parents/guardians was conducted on their tolerance of transfusing RhD-positive blood to RhD-negative female children ≤17 years old at four level 1 pediatric hospitals. RESULTS: In total, 621 parents/guardians were approached of whom 378/621 (61%) completed the survey in its entirety and were included in the analysis. Respondents were mostly females [295/378 (78%)], White [242/378 (64%)], had some college education [217/378 (57%)] and less than $60,000 annual income [193/378 (51%)]. Respondents had a total of 547 female children. Most children's ABO [320/547 (59%)] and RhD type [348/547 (64%)] were not known by their parents; of children with known RhD type, 58/186 (31%) were RhD-negative. When the risk of harm to a future fetus was given as 0-6%, more than 80% of respondents indicated that they were likely to accept RhD-positive blood transfusions on behalf of RhD-negative female children in a life-threatening situation. The rate of willingness to accept emergent RhD-incompatible blood transfusions significantly increased as the potential survival benefit of the transfusion increased. CONCLUSION: Most parents were willing to accept RhD-positive blood products on behalf of RhD-negative female children in an emergency situation. Further discussions and evidence-based guidelines on transfusing RhD-positive blood products to RhD-unknown females in emergency settings are needed.
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Sistema del Grupo Sanguíneo Rh-Hr , Reacción a la Transfusión , Humanos , Femenino , Niño , Adolescente , Masculino , Transfusión Sanguínea , Incompatibilidad de Grupos Sanguíneos , FetoRESUMEN
OBJECTIVES: Use of firearm locking devices may reduce the risk of suicide and injury among older adults. This study describes older adults' preferences when choosing a firearm locking device. METHODS: We conducted a secondary analysis of a nationally representative survey of US adult firearm owners (N = 2,152). We compared older adults (≥65y) with relatively younger adults (<65y), stratified by self-reported gender. RESULTS: The top three factors cited as impacting firearm locking device selection included speed (53.6%) and ease of firearm access from device (52.4%), and cost of the device (28.7%). These top factors were comparable for all adults across genders. A larger proportion of older vs younger males reported that a primary preference was whether the device allows the firearm to remain loaded with ammunition; smaller proportions of older vs younger males reported strength of device (device durability) and costs. CONCLUSIONS: Preference among older adults, particularly older males, for locking devices that maintain the firearms easy to access - especially, loaded with ammunition - might impact firearm injury prevention efforts for this high-risk group. CLINICAL IMPLICATIONS: For harm reduction, use of any firearm locking device may reduce the risk of firearm injury or death. Clinicians are encouraged to explore reasons for locking device selection within motivational interviewing frameworks.
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BACKGROUND: The intra-operative classification of appendicitis defines postoperative treatment. The correct designation can influence patient recovery, complications and hospital costs. Recent research has shown that intra-operative classification criteria varies among surgeons, and is not always the same as the pathologist's report. Classification accuracy can lower costs by preventing unnecessary treatment or sub-optimal interventions. METHODS: During a period of 4 months, N = 133 appendix specimens were received and evaluated by the pathology department of a single teaching hospital. Five surgeons extracted the specimens and one experienced pathologist drew the histopathology reports. A comparison between the surgeons' classifications and the pathologist's was made. Classification accuracy was determined and statistical analyses was performed using chi-square, and p values were obtained. A p < 0.05 was considered significant. RESULTS: A total of N = 133 specimens were obtained, 127 belonged to patients following emergency surgery due to acute abdominal pain; the other six were from elective hemi-colectomies for right colonic adenocarcinomas, and were not included. Of the 127 specimens analyzed, 14 (11%) were negative, 21 (16.5%) were edematous, 81 (63.7%) were phlegmonous and 11 (8.6%) were gangrenous. A total of 18 (14%) perforated appendices were also reported. Surgical accuracy was 60.6% (N = 67) with a statistically significant p < 0.001. Only five patients with incorrect intraoperative classifications received unnecessary or lacked treatment. CONCLUSIONS: An overall accuracy of 60.6% is seen when the surgical classification is compared to the pathological classification. Although the surgeons' accuracy is low when comparing intra-operative versus histopathological classification, this variation in designation does not affect postoperative treatment significantly.
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Apendicectomía , Apendicitis/diagnóstico , Apendicitis/etiología , Cuidados Posoperatorios , Adulto , Apendicitis/cirugía , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
The treatment of ST-segment elevation myocardial infarction has barriers depending on the geographic region. Primary coronary angioplasty is the treatment of choice, if it is performed on time and by experienced operators. However, when it is not available, the administration of fibrinolysis and referral for rescue angioplasty, in case of negative reperfusion, is the best strategy. In the same way, coronary angioplasty, as part of a pharmacoinvasive strategy, is the best alternative when there is positive reperfusion. The development of infarct treatment networks increases the number of patients reperfused within the recommended times and improves outcomes. In Latin America, national myocardial infarction treatment programs should focus on improving outcomes, and long-term success depends on working toward defined goals and enhancing functionality, therefore programs should develop capacity to measure their performance. The following document discusses all of these alternatives and suggests opportunities for improvement.
El tratamiento del infarto agudo de miocardio con elevación del segmento ST tiene barreras dependiendo de la región geográfica. La angioplastia coronaria primaria es el tratamiento de elección, siempre y cuando sea realizada dentro de tiempo y por operadores experimentados. Sin embargo, cuando no está disponible, la administración de fibrinólisis y el envío para angioplastia de rescate, en caso de reperfusión negativa, es la mejor estrategia. De la misma manera, la angioplastia coronaria, como parte de una estrategia farmacoinvasiva, es la mejor alternativa cuando hay reperfusión positiva. El desarrollo de redes de tratamiento del infarto aumenta el número de pacientes reperfundidos dentro de los tiempos recomendados y mejora los desenlaces. En América Latina, los programas nacionales para el tratamiento del infarto deben centrarse en mejorar los resultados y el éxito a largo plazo depende de trabajar hacia objetivos definidos y obtener métricas de rendimiento, por lo tanto, estos deben desarrollar métricas para cuantificar su desempeño. El siguiente documento discute todas estas alternativas y sugiere oportunidades de mejora.
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The diagnostic criteria, treatments at the time of admission, and drugs used in patients with acute coronary syndrome are well defined in countless guidelines. However, there is uncertainty about the measures to recommend during patient discharge planning. This document brings together the most recent evidence and the standardized and optimal treatment for patients at the time of discharge from hospitalization for an acute coronary syndrome, for comprehensive and safe care in the patient's transition between care from the acute event to the outpatient care, with the aim of optimizing the recovery of viable myocardium, guaranteeing the most appropriate secondary prevention, reducing the risk of a new coronary event and mortality, as well as the adequate reintegration of patients into daily life.
Los criterios diagnósticos, los tratamientos en el momento de la admisión y los fármacos utilizados en pacientes con síndrome coronario agudo están bien definidos en innumerables guías. Sin embargo, existe incertidumbre acerca de las medidas para recomendar durante la planificación del egreso de los pacientes. Este documento reúne las evidencias más recientes y el tratamiento estandarizado y óptimo para los pacientes al momento del egreso de una hospitalización por un síndrome coronario agudo, para un cuidado integral y seguro en la transición del paciente entre la atención del evento agudo y el cuidado ambulatorio, con el objetivo de optimizar la recuperación de miocardio viable, garantizar la prevención secundaria más adecuada, reducir el riesgo de un nuevo evento coronario y la mortalidad, así como la adecuada reinserción de los pacientes en la vida cotidiana.
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Síndrome Coronario Agudo , Alta del Paciente , Síndrome Coronario Agudo/terapia , Síndrome Coronario Agudo/diagnóstico , Humanos , América Latina , Guías de Práctica Clínica como AsuntoRESUMEN
APPL1 is an adaptor protein that plays a critical role in regulating adiponectin and insulin signaling. However, how APPL1 is regulated under normal and pathological conditions remains largely unknown. In this study, we show that APPL1 undergoes phosphorylation at Ser(430) and that this phosphorylation is enhanced in the liver of obese mice displaying insulin resistance. In cultured mouse hepatocytes, APPL1 phosphorylation at Ser(430) is stimulated by phorbol 12-myristate 13-acetate, an activator of classic PKC isoforms, and by the endoplasmic reticulum (ER) stress inducer, thapsigargin. Overexpression of wild-type but not dominant negative PKCα increases APPL1 phosphorylation at Ser(430) in mouse hepatocytes. In addition, suppressing PKCα expression by shRNA in hepatocytes reduces ER stress-induced APPL1 phosphorylation at Ser(430) as well as the inhibitory effect of ER stress on insulin-stimulated Akt phosphorylation. Consistent with a negative regulatory role of APPL1 phosphorylation at Ser(430) in insulin signaling, overexpression of APPL1(S430D) but not APPL1(S430A) impairs the potentiating effect of APPL1 on insulin-stimulated Akt phosphorylation at Thr(308). Taken together, our results identify APPL1 as a novel target in ER stress-induced insulin resistance and PKCα as the kinase mediating ER stress-induced phosphorylation of APPL1 at Ser(430).
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Proteínas Adaptadoras Transductoras de Señales/metabolismo , Estrés del Retículo Endoplásmico , Hepatocitos/metabolismo , Resistencia a la Insulina , Procesamiento Proteico-Postraduccional , Animales , Línea Celular , Activadores de Enzimas/farmacología , Hepatocitos/enzimología , Humanos , Insulina/fisiología , Isoenzimas/metabolismo , Hígado/enzimología , Hígado/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Obesos , Obesidad/metabolismo , Fosforilación , Proteína Quinasa C-alfa/metabolismo , Serina/metabolismo , Transducción de Señal , Acetato de Tetradecanoilforbol/farmacologíaRESUMEN
BACKGROUND: The identification of gastric polyps incidentally in endoscopies of the upper digestive tract has increased its incidence, varying between 0.5% and 23%. 10% of these polyps have symptoms, 40% are hyperplastic. We allow ourselves to propose a laparoscopic technique for the management of giant hyperplastic polyps associated with a pyloric syndrome, not susceptible to endoscopic resection. METHOD: A series of patients approached by laparoscopic transgastric polypectomy due to the giant gastric polyps associated with pyloric syndrome, in Bogotá, Colombia, from January 2015 to December 2018. RESULTS: Seven patients, 85% female, with an average age of 51 years, who were admitted for pyloric syndrome and were taken to laparoscopic management, with an average surgical time of 42 min, intraoperative bleeding 7-8 cc, tolerance to the oral route 24 hours, no conversion, without mortality. CONCLUSIONS: Transgastric polypectomy for the management of benign giant gastric polyps that cannot be resected endoscopically turns out to be a feasible method, with a low rate of complications and without mortality.
ANTECEDENTES: La identificación de pólipos gástricos de manera incidental en endoscopias de vías digestivas altas ha aumentado su incidencia, que varía entre el 0.5% y el 23%. El 10% de estos pólipos presentan síntomas y el 40% son hiperplásicos. Nos permitimos proponer una técnica laparoscópica para el manejo de los pólipos hiperplásicos gigantes asociados a síndrome pilórico no susceptibles de resección endoscópica. MÉTODO: Serie de pacientes llevados a polipectomía transgástrica laparoscópica por hallazgo de pólipos gástricos gigantes asociados a síndrome pilórico, en Bogotá, Colombia, de enero de 2015 a diciembre de 2018. RESULTADOS: Un total de siete pacientes, el 85% de sexo femenino, con edad promedio de 51 años, ingresaron por síndrome pilórico y fueron llevados a manejo laparoscópico, con un tiempo quirúrgico promedio de 42 minutos, sangrado intraoperatorio de 7-8 cc, tolerancia a la vía oral a las 24 horas, no conversión, sin mortalidad. CONCLUSIONES: La polipectomía transgástrica para el manejo de pólipos gástricos gigantes benignos que no pueden ser resecados por vía endoscópica resulta ser un método factible, con una baja tasa de complicaciones y sin mortalidad.
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Pólipos Adenomatosos , Laparoscopía , Pólipos , Neoplasias Gástricas , Humanos , Femenino , Persona de Mediana Edad , Masculino , Pólipos/cirugía , Pólipos/complicaciones , Neoplasias Gástricas/cirugía , Pólipos Adenomatosos/cirugíaRESUMEN
BACKGROUND: Traumatic brain injury (TBI) affects civilian and military populations with high morbidity and mortality rates and devastating sequelae. As the US military shifts its operational paradigm to prepare for future large-scale combat operations, the need for prolonged casualty care is expected to intensify. Identifying efficacious prehospital TBI management strategies is therefore vital. Numerous pharmacotherapies are beneficial in the inpatient management of TBI, including beta blockers, calcium channel blockers, statins, and other agents. However, their utility in prehospital management of moderate or severe TBI is not well understood. We performed a systematic review to elucidate agents of potential prehospital benefit in moderate and severe TBI. METHODS: We searched 6 databases from January 2000 through December 2021 without limitations in outcome metrics using a variety of search terms designed to encapsulate all studies pertaining to prehospital TBI management. We identified 2,142 unique articles, which netted 114 studies for full review. Seven studies met stringent inclusion criteria for our aims. RESULTS: Studies meeting inclusion criteria assessed tranexamic acid (TXA) (n=6) and ethanol (n=1). Of the TXA studies, 3 were randomized controlled trials, 2 were retrospective cohort studies, 1 was a prospective cohort study, and 1 was a meta-analysis. Notably absent were papers investigating therapeutics shown to be beneficial in inpatient hospital treatment of TBI. Overall, data suggest TXA administration is potentially beneficial in moderate or severe TBI with or without intracranial hemorrhage. Severe TBI with or without penetrating trauma was associated with worse overall outcomes, regardless of TXA use. CONCLUSION: Effective interventions for treating moderate or severe TBI are lacking. TXA is the most widely studied pharmacologic intervention and appears to offer some benefit without adverse effects in moderate TBI (with or without intracranial hemorrhage) in the pre-hospital setting despite heterogeneous results. Limitations of these studies include heterogeneity in outcome metrics, patient populations, and circumstances of TXA use. We identified a gap in the literature in translating agents with demonstrated inpatient benefit to the prehospital setting. Further investigation into these and other novel therapeutic options in the prehospital arena is crucial to improving clinical outcomes in TBI.
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Antifibrinolíticos , Lesiones Traumáticas del Encéfalo , Servicios Médicos de Urgencia , Ácido Tranexámico , Humanos , Antifibrinolíticos/uso terapéutico , Lesiones Traumáticas del Encéfalo/tratamiento farmacológico , Servicios Médicos de Urgencia/métodos , Hemorragias Intracraneales/tratamiento farmacológico , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Ácido Tranexámico/uso terapéutico , Metaanálisis como AsuntoRESUMEN
INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The standard management for localized GIST is the complete surgical resection. For this procedure, laparoendoscopic cooperative surgery (LECS) has been proposed as a safe and effective alternative. We want to show our experience with LECS technique for the management of GIST and a literature review. MATERIALS AND METHODS: A retrospective, cross-sectional study was carried out, which included patients with a diagnosis of localized GIST treated with LECS technique between January 2011 and December 2018. RESULTS: During the period of the study, 21 patients were managed by LECS technique, with a male-female rate 3:1. Average surgical time was 98.5 min, 100% negative borders in all patients. Intraoperative bleeding was 30.7 cc and all patients had orally tolerance in the first 24 h. None of them required ICU management, no mortality was reported. CONCLUSIONS: The LECS technique has demonstrated to be a viable, safe, and effective technique for the management of gastric GIST's, showing superiority in organ function preservation and in the range of oncological margins. Prospective studies are necessary to obtain knowledge about the outcome of patients managed through LECS technique.
INTRODUCCIÓN: Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquimales más comunes del tracto gastrointestinal. El tratamiento estándar para los GIST localizados es la resección quirúrgica completa. Para este procedimiento, el abordaje cooperativo laparo-endocopico (ACLE) se ha propuesto como una alternativa segura y eficaz. Queremos mostrar nuestra experiencia con la técnica ACLE para el manejo de GIST y unzaa revisión de la literatura. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, transversal, que incluyó pacientes con diagnóstico de GIST localizado tratados con la técnica ACLE entre enero de 2011 y diciembre de 2018. RESULTADOS: Durante el periodo de estudio se manejaron 21 pacientes con técnica de ACLE, con una tasa hombre-mujer de 3:1. El tiempo quirúrgico promedio fue de 98.5 min, con 100% de bordes negativos en todos los pacientes. El sangrado intraoperatorio fue de 30.7 cc y todos los pacientes tuvieron tolerancia oral en las primeras 24H. Ninguno de ellos requirió manejo en UCI, no se reportó mortalidad. CONCLUSIONES: La técnica ACLE ha demostrado ser una técnica viable, segura y eficaz para el manejo de los GIST gástricos. Mostrando superioridad en la preservación de la función orgánica y en los magines oncológicos. Son necesarios estudios prospectivos para conocer el resultado de los pacientes manejados mediante la técnica ACLE.
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Tumores del Estroma Gastrointestinal , Laparoscopía , Neoplasias Gástricas , Estudios Transversales , Femenino , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Laparoscopía/métodos , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Neoplasias Gástricas/cirugía , Resultado del TratamientoRESUMEN
The clinical presentation of acute coronary syndromes (ACS) as ST-elevation ACS (STEACS) or non-ST-elevation ACS (NSTEACS) differs between women and men. The aim of this study was to describe the difference in the clinical presentation of ACS between sexes. A total of 10,019 patients included in the Epi-Cardio Registry were analyzed. A higher proportion of women than men presented with NSTEACS (60.3% vs 46.7%; P <0.001). The difference between sexes was driven by a higher prevalence of ACS with non-obstructive coronary arteries (20.9% vs 6.6%) mainly in young women, since ACS without coronary lesions were mostly NSTEACS (77.7% vs 22.3%). In patients with obstructive coronary heart disease, there were no differences in the clinical presentation between sexes. In conclusion, younger women are more likely than men to present ACS with non-obstructive coronary arteries, whereas no significant difference exists between sexes regarding the prevalence of ACS with obstructive coronary artery disease.
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Síndrome Coronario Agudo , Enfermedad de la Arteria Coronaria , Femenino , Humanos , Masculino , Sistema de Registros , Caracteres SexualesRESUMEN
The universality of cognitive processes has been called into question. Research suggests that individuals from Eastern cultures (e.g., China, Korea) when compared to individuals from Western cultures (e.g., the United States) prefer to reason holistically. This line of research has not been extended to cultural groups far removed from cultures traditionally surveyed in cross-cultural research such as Hispanics. We conducted two studies to understand: 1) the generalizability of the construct of holistic reasoning in Mexicans, and 2) the preferred reasoning style of Mexicans when compared to U.S. Americans. Results support the generalization of the factor structure of holistic reasoning as originally hypothesized by Choi, Koo, and Choi (2007). The results of Study 2 suggest that Mexicans scored higher than U.S. Americans on certain aspects of holistic reasoning.
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Cognición , Comparación Transcultural , Características Culturales , Americanos Mexicanos/psicología , Pensamiento , Adulto , Análisis Factorial , Femenino , Humanos , Masculino , México , Solución de Problemas , Pruebas Psicológicas , Reproducibilidad de los Resultados , Estados Unidos , Adulto JovenRESUMEN
AIM OF THE STUDY: Laparoscopic adhesiolysis in small bowel obstruction (SBO) is getting increasingly normal. In patients with multiple adhesive SBOs (MASBO), laparoscopic approaches might increase the risk of bowel injury due to the distended and potentially compromised small bowel. It remains a challenge to the surgeons, entails an interdisciplinary team, trying to achieve the least complications as possible. The study aimed to compare surgical outcomes of laparoscopic procedures (multi-port vs. single-port) in the management of MASBO. PATIENTS AND METHODS: Comparative study of 68 patients with post-operative MASBO treated with Single-Port single incision laparoscopic surgery (SILS) and Multi-port Laparoscopic Surgery in two centers of Bogota, Colombia between January 2013 and June 2018. RESULTS: All patients underwent laparoscopic management, 27 patients by SILS, and 41 patients by multi-port. The average surgical time in the multiport approach was 167 min versus SILS with 129 min. Laparoscopic intestinal resection was performed in 4.4% of patients, through multi-port using intracorporeal anastomosis. Mean hospital stay of 3.2 days for the SILS approach versus multi-port in 2.2 days. CONCLUSIONS: Both laparoscopic approaches, in MASBO treatment is feasible in qualified hands. Patient selection and medical judgment seem to be the most essential factors for a positive result.
OBJETIVOS DEL ESTUDIO: Cada día es más frecuente la adherensiolisis laparoscópica en obstrucción del intestino delgado. En pacientes con obstrucciones debidas a múltiples adherencias del intestino delgado (OMAID), los abordajes laparoscópicos pueden incrementar el riesgo de daño de víscera hueca debido a la presencia de asas distendidas. Continúa siendo un reto para el cirujano, requiriendo un grupo interdisciplinario para disminuir las posibles complicaciones. Este estudio busca comparar los desenlaces de abordajes laparoscópicos (Multipuerto vs. monopuerto) en el manejo del OMAID. PACIENTES Y MÉTODOS: Se realizó un estudio de 68 pacientes con OMAID postoperatorio tratado con cirugía laparoscópica de monopuerto y múltipuerto en dos centros de Bogotá, Colombia entre enero de 2013 y junio de 2018. RESULTADOS: Pacientes llevados a manejo laparoscópico, 27 por monopuerto y 41 por múltipuerto, con tiempo quirúrgico promedio de 129 y 167 minutos respectivamente. 4.1% de los pacientes requirieron resección intestinal, todas en pacientes con abordaje múltipuerto con anastomosis intracorpóreas. El tiempo medio de hospitalización fue de 3.2 días para monopuerto y 2.2 días para multipuerto. CONCLUSIONES: Ambos abordajes laparoscópicos son factibles para el manejo del OMAID en manos calificadas. La selección del paciente y el juicio médico parecen ser factores fundamentales en el resultado positivo.
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Obstrucción Intestinal , Laparoscopía , Adhesivos , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado/cirugía , Tiempo de Internación , Tempo Operativo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND STUDY AIMS: The COVID-19 outbreak has reorganized surgical team conditions regarding endoscopy. The number of interventions has been reduced, the number of healthcare professionals must be limited, and both the patients and physicians are more protected than ever. PATIENTS AND METHODS: In the highest peak of contagion in Colombia, endoscopy, colonoscopy, and esophagogastroduodenoscopy were performed using a low-cost disposable device. A total of 1388 procedures were performed. Every patient was assessed for symptoms via a telephone call, at the health center, and after the procedure, following specific attention routes. RESULTS: After procedure follow-up, no positive cases of COVID-19 were noted. CONCLUSION: The methodology reduced the risk of infection during the COVID-19 pandemic.
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COVID-19 , Endoscopía , Telemedicina , COVID-19/prevención & control , Colombia , Equipos Desechables , Endoscopía/instrumentación , Endoscopía/métodos , Humanos , PandemiasRESUMEN
Antecedentes: El corazón pulmonar crónico (CPC) muestra un incremento en habitantes que viven en grandes altitudes. Objetivo: Investigar la frecuencia de arritmias cardíacas y factores de riesgo para su desarrollo. Métodos: Estudio descriptivo y transversal; se revisó el registro de pacientes internados del Departamento de Cardiología del Instituto Nacional de Tórax, La Paz, Bolivia, entre enero de 2017 y junio de 2018; se incorporó a todos los individuos con diagnóstico de CPC, definido por criterios clínicos, electrocardiográficos y ecocardiográficos; se incluyó a 162 pacientes que cumplieron los criterios en el análisis; se utilizaron la t de Student y ANOVA. Resultados: Arritmias: fibrilación auricular (FA), 125 (75%); aleteo auricular (AA), 17 (10.5%); taquicardia auricular (TA), 17 (10.5%); extrasístoles, 3 (1.9%). Según el análisis univariado, los factores relacionados con el desarrollo de arritmias fueron: eritrocitosis: FA, RR: 1.33, otras arritmias (RR: 1.67), p = 0.0001; hipertensión arterial pulmonar: FA, RR: 3.10, otras arritmias (RR: 3.21), p = 0.0001; dilatación de aurícula derecha (AD): FA, RR: 1.92, otras arritmias (RR: 2.13), p = 0.0001; obesidad: FA, RR: 3.47, p = 0.001, otras arritmias (RR: 3.70), p = 0.001; hipertensión arterial sistémica: FA, RR: 3.10, p = 0.001, otras arritmias (RR: 3.21), p = 0.001. Según el análisis multivariado: eritrocitosis (RR: 2.2), dilatación de AD (RR: 1.2), p = 0.0001. Conclusiones: Se encontró FA con mayor frecuencia en los pacientes con CPC; los factores de riesgo con mayor significancia estadística para su presentación fueron la eritrocitosis y la dilatación de la AD. Background: Chronic cor pulmonale (CPC), with increased presentation in high-altitude inhabitants. Objectives: Investigating the frequency of cardiac arrhythmias, and risk factors for its development. Methods: Descriptive, cross-sectional study, the inpatient registry of the Department of Cardiology of the National Institute of Torax, La Paz-Bolivia, from January 2017 to June 2018 was reviewed, all were incorporated with the diagnosis of CPC, defined by clinical criteria, electrocardiographic and echocardiographic, 162 patients who met the criteria were taken, the student's t-test and ANOVA were used for the analysis. Results: Arrhythmias: atrial fibrillation (AF) 125 (75%), atrial flutter (AA) 17 (10.5%), atrial tachycardia (AT) 17 (10.5%), extrasystoles 3 (1.9%). Univariate analysis of factors related to the development of arrhythmias: erythrocytosis: FA, RR: 1.33, other arrhythmias RR: 1.67, p = 0.0001, pulmonary arterial hypertension: FA, RR: 3.10, other arrhythmias RR: 3.21, p = 0.0001, right atrial dilation (AD): FA, RR: 1.92, other arrhythmias RR: 2.13, p = 0.0001, obesity: FA, RR: 3.47, p = 0.001, other arrhythmias RR: 3.70, p = 0.001, systemic arterial hypertension: FA: RR: 3.10, p = 0.001, other arrhythmias RR: 3.21, p = 0.001. Multivariate analysis: erythrocytosis (RR: 2.2), AD dilation (RR: 1.2), p = 0.0001. Conclusions: AF was found more frequently in patients with CPC, the risk factors with the greatest statistical significance for presentation were: erythrocytosis and AD dilation.
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Altitud , Arritmias Cardíacas/epidemiología , Enfermedad Cardiopulmonar/epidemiología , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , Bolivia/epidemiología , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Policitemia/epidemiología , Sistema de Registros , Factores de RiesgoRESUMEN
BACKGROUND: The endoscopic video capsule (EVC), a minimally invasive method of study of the gastrointestinal system indicated in occult gastrointestinal bleeding, has as main complication the retention of endoscopic capsule (CR), currently it is managed with direct extraction using double-balloon enteroscopy; however, when it fails due to its location or associated pathologies, the surgical intervention results in the most successful approach. OBJECTIVE: To evaluate clinical characteristics and management of patients with video capsule endoscopy retention. METHOD: From January 2001 to December 2018, a retrospective search was carried out in three centers, of patients with CR diagnosis, clinical variables and approach were evaluated, in addition to a critical review of the literature. RESULTS: 15 patients with a diagnosis of CR (eight 8 women and seven men), average age 65 (range: 45-77). Seven required surgical management, three endoscopic and five medical management. CONCLUSIONS: The CR is a new pathology of low prevalence, the surgical management resulting from a second therapeutic line when the removal of the VCE has not been possible endoscopically, this pathology requires special attention in the patient's medical history and symptoms for diagnosis and management.
ANTECEDENTES: La videocápsula endoscópica (VCE), método mínimamente invasivo de estudio del sistema gastrointestinal indicado en hemorragia digestiva oculta, tiene como principal complicación la retención de la cápsula endoscópica (RCE). Actualmente se maneja con extracción directa empleando enteroscopia de doble balón; sin embargo, cuando falla por su localización o por patologías asociadas, la intervención quirúrgica resulta el método de mayor éxito. OBJETIVO: Evaluar las características clínicas y el manejo de pacientes con RCE. MÉTODO: De enero de 2001 a diciembre de 2018 se realizó un búsqueda retrospectiva, en tres centros, de pacientes con diagnóstico de RCE. Se evaluaron variables clínicas y de manejo, y además se realizó una revisión crítica de la literatura. RESULTADOS: Se hallaron 15 pacientes con diagnóstico de RCE (ocho mujeres y siete hombres), con una edad promedio de 65 años (rango: 45-77). Siete requirieron manejo quirúrgico, tres manejo endoscópico y cinco manejo médico. CONCLUSIONES: La RCE es una patología nueva de baja prevalencia. El manejo quirúrgico resulta ser una segunda línea terapéutica cuando la extracción de la VCE no ha sido posible endoscópicamente. Para su diagnóstico y manejo, esta patología requiere una especial atención a la historia clínica, los antecedentes y los síntomas de los pacientes.
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Endoscopía Capsular , Pica , Anciano , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Background: Despite the effectiveness of laparoscopic common bile duct (CBD) surgery, no case series details the use and advantages of laparoscopic CBD exploration (LCBDE) without use of intraoperative cholangiography (IOC) in endoscopic retrograde cholangiopancreatography (ERCP) failure. Therefore, we present a case series regarding our success with LCBDE in managing CBD stones (CBDSs) using laparoscopic technique without IOC. Materials and Methods: We performed a descriptive retrospective observational study. Patients with CBDSs, alone or along with gallbladder stones, were treated through LCBDE with primary CBD closure after failed ERCP. Results: All patients underwent LCBDE with choledocotomy and primary duct closure. Patients with gallbladder stones underwent laparoscopic cholecystectomy (78%). All procedures were successful, and no conversions occurred. Surgery duration averaged 106 minutes. Intraoperative bleeding averaged 15 cc, and no mortalities occurred. No patients required additional surgery or intensive care unit admission. Hospitalization duration averaged 5 days. Conclusions: Therefore, a laparoscopic approach with primary CBD closure after failed ERCP for complex CBDSs is safe and effective.
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Coledocolitiasis/diagnóstico por imagen , Coledocolitiasis/cirugía , Conducto Colédoco/cirugía , Laparoscopía/métodos , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía Laparoscópica , Coledocolitiasis/complicaciones , Colombia , Femenino , Cálculos Biliares/complicaciones , Cálculos Biliares/cirugía , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Reoperación , Estudios Retrospectivos , Insuficiencia del Tratamiento , Técnicas de Cierre de HeridasRESUMEN
Cardiovascular diseases are the leading cause of death in most regions of the world, usually followed by infectious diseases. For decades, infections in general, and particularly those involving the respiratory system, have been known to be associated with an increased risk of cardiovascular and cerebrovascular events, and their consequent morbidity and mortality. Although vaccines are an excellent strategy in the prevention of infectious diseases, the proportion of immunized adults in our country is frankly deficient. Multiple barriers contribute to perpetuating this problem, within which the lack of prescription of the same by professionals who care for vulnerable populations occupies a central place. Patients with cardiovascular disease represent a particularly risky subpopulation. The spectrum of pathologies that can trigger respiratory infections is wide: development or worsening of heart failure, arrhythmias, acute coronary syndromes and cerebrovascular diseases, among the main ones. The role of immunoprophylaxis with influenza, pneumococcal and tetanus vaccine in patients with different heart diseases is addressed here, evaluating the evidence supporting its use, and placing special emphasis on practical aspects of its use, such as adverse effects, contraindications and special care situations, such as congenital heart disease in adults, heart transplantation, anticoagulation or egg allergy. Thus, this document aims to assist in decision-making for any doctor involved in the care of patients with cardiovascular disease.
Las enfermedades cardiovasculares ocupan la primera causa de muerte en la mayoría de las regiones del mundo, seguidas habitualmente por las enfermedades infecciosas. Desde hace décadas se conoce que las infecciones en general, y particularmente las que involucran el aparato respiratorio, se vinculan con un incremento en el riesgo de eventos cardiovasculares y cerebrovasculares, y su consecuente morbimortalidad. Si bien las vacunas constituyen una excelente estrategia en la prevención de enfermedades infectocontagiosas, la proporción de adultos inmunizados en nuestro país es francamente deficitaria. Múltiples barreras contribuyen a perpetuar esta problemática, dentro de las cuales la falta de prescripción de las mismas por parte de los profesionales que atienden a poblaciones vulnerables ocupa un lugar central. Los pacientes con enfermedades cardiovasculares representan una subpoblación de particular riesgo. El espectro de enfermedades que pueden originar las infecciones respiratorias es amplio: desarrollo o empeoramiento de insuficiencia cardíaca, arritmias, síndromes coronarios agudos y enfermedades cerebrovasculares, entre los principales. Se aborda aquí el rol de la inmunoprofilaxis con vacuna antigripal, antineumocócica y antitetánica en pacientes con diferentes cardiopatías, valorando la evidencia que respalda su empleo y haciendo especial hincapié en aspectos prácticos de su utilización, como efectos adversos, contraindicaciones y situaciones especiales de atención: cardiopatías congénitas del adulto, trasplante cardíaco, individuos anticoagulados o con alergia al huevo. Así, este documento tiene como objetivo asistir en la toma de decisiones a cualquier médico involucrado en el cuidado de pacientes con enfermedad cardiovascular.
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Enfermedades Cardiovasculares/epidemiología , Inmunización , Adulto , Cardiología , Enfermedades Cardiovasculares/prevención & control , Consenso , Hipersensibilidad al Huevo , HumanosRESUMEN
OBJECTIVE: To compare voice outcomes of autogenous fat injection versus medialization laryngoplasty in patients with glottic insufficiency due to vocal fold paresis or atrophy. METHODS: A retrospective review was performed from 2009 to 2017 of all patients who underwent lipoinjection or medialization laryngoplasty (ML) for glottic insufficiency. Charts were reviewed for demographic information, preoperative diagnosis, surgical intervention, Voice Handicap Index-10 (VHI-10) and Glottal Function Index (GFI) scores, follow-up time (minimum 3 months), and concomitant voice therapy. RESULTS: Eighty-three patients were initially identified and limited to 28 based on the inclusion/exclusion criteria. Thirty-five procedures were performed with a total of 15 fat injections and 20 MLs. The mean age was 60.7 years in the lipoinjection group and 55.6 years in the ML group. There was no significant difference in pretreatment VHI-10 scores between the two groups. Using the lowest recorded voice scores during the follow-up period, both groups had a significant decrease (P < 0.05) compared to preoperative scores (VHI-10: fat decreased from 27.8 to 14.2, ML decreased from 30.5 to 9.1; GFI: fat decreased from 13.7 to 5.27, ML decreased from 13.6 to 4.6). When evaluating the entire follow-up period (median 19 months in fat group, 16.3 months in ML), only the ML group maintained a significant improvement in VHI-10 (median delta 14.5) and GFI (median delta 7) compared to preoperative scores. CONCLUSION: Although both autogenous fat injection and ML result in improved voice scores in the short term, the effect of fat injection appears to be limited, as evidenced by worsening VHI-10 and GFI scores over time. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1164-1168, 2019.