Prevalence of Helicobacter pylori infection among patients with esophageal carcinoma.

BACKGROUND: Helicobacter pylori (H. pylori) is a widespread microorganism related to gastric adenocarcinoma (AC). In contrast, it has been reported that an inverse association exists between H. pylori infection and esophageal carcinoma. The mechanisms underlying this supposedly protective effect remain controversial. AIM: To determine the prevalence of H. pylori infection in esophageal carcinoma patients, we performed a retrospective observational study of esophageal tumors diagnosed in our hospital. METHODS: We retrospectively reviewed the prevalence of H. pylori infection in a cohort of patients diagnosed with esophageal carcinoma. Concomitant or previous proton pump inhibitor (PPI) usage was also recorded. RESULTS: A total of 89 patients with esophageal carcinoma (69 males, 77.5%), with a mean age of 66 years (range, 26-93 years) were included. AC was the most frequent pathological variant (n = 47, 52.8%), followed by squamous cell carcinoma (n = 37, 41.6%). Fourteen ACs (29.8%) originated in the gastroesophageal junction and 33 (70.2%) in the esophageal body. Overall, 54 patients (60.7%) presented at stages III and IV. Previous H. pylori infection occurred only in 4 patients (4.5%), 3 with AC (6.3% of all ACs) and 1 with squamous cell carcinoma (2.7% of all squamous cell tumors). All patients with previous H. pylori infection had stage III-IV. Only one patient had received prior H. pylori eradication therapy, whereas 86 (96.6%) had received previous or concomitant PPI treatment. CONCLUSION: In our cohort of patients, and after histologic evaluation of paraffin-embedded primary tumors, we found a very low prevalence of previous H. pylori infection. We also reviewed the medical history of the patients, concluding that the majority had received or were on PPI treatment. The minimal prevalence of H. pylori infection found in this cohort of patients with esophageal carcinoma suggests a protective role.

Drug-Induced Reorganisation of Lipid Metabolism Limits the Therapeutic Efficacy of Ponatinib in Glioma Stem Cells.

The standard of care for glioblastoma (GBM) involves surgery followed by adjuvant radio- and chemotherapy, but often within months, patients relapse, and this has been linked to glioma stem cells (GSCs), self-renewing cells with increased therapy resistance. The identification of the epidermal growth factor receptor (EGFR) and platelet-derived growth factor receptor (PDGFR) as key players in gliomagenesis inspired the development of inhibitors targeting these tyrosine kinases (TKIs). However, results from clinical trials testing TKIs have been disappointing, and while the role of GSCs in conventional therapy resistance has been extensively studied, less is known about resistance of GSCs to TKIs. In this study, we have used compartmentalised proteomics to analyse the adaptive response of GSCs to ponatinib, a TKI with activity against PDGFR. The analysis of differentially expressed proteins revealed that GSCs respond to ponatinib by broadly rewiring lipid metabolism, involving fatty acid beta-oxidation, cholesterol synthesis, and sphingolipid degradation. Inhibiting each of these metabolic pathways overcame ponatinib adaptation of GSCs, but interrogation of patient data revealed sphingolipid degradation as the most relevant pathway in GBM. Our data highlight that targeting lipid metabolism, and particularly sphingolipid degradation in combinatorial therapies, could improve the outcome of TKI therapies using ponatinib in GBM.

Transcutaneous auricular vagus nerve stimulation to acutely reduce emotional vulnerability and improve emotional regulation in borderline personality disorder (tVNS-BPD): study protocol for a randomized, single-blind, sham-controlled trial.

BACKGROUND: Borderline personality disorder (BPD) is considered a disorder of emotion regulation resulting from the expression of a biologically determined emotional vulnerability (that is, heightened sensitivity to emotion, increased emotional intensity/reactivity, and a slow return to emotional baseline) combined with exposure to invalidating environments. Vagal tone has been associated with activity in cortical regions involved in emotion regulation and a lower resting state of vagal tone has been observed in BPD patients relative to healthy controls. Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has been shown to reduce temper outbursts in adults with Prader-Willi Syndrome, to enhance recognition of emotions in healthy students, and to improve depressive and anxiety symptoms. Furthermore, a single session of taVNS has been shown to acutely alter the recognition of facial expressions of negative valence in adolescents with MDD and increase emotion recognition in controls. However, the effect of taVNS on emotional vulnerability and regulation in individuals diagnosed with BPD has not been investigated. Our aims are to determine if taVNS is effective in acutely reducing emotional vulnerability and improve emotional regulation in BPD patients. METHODS: Forty-two patients will be randomized to a single session of taVNS or sham-taVNS while going through an affect induction procedure. It will consist of the presentation of one neutral and three negative affect-evoking 4-min-long videos in sequence, each of which is followed by a 4-min post-induction period during which participants will rate the quality and intensity of their current self-reported emotions (post-induction ratings) and the perceived effectiveness in managing their emotions during the video presentation. The rating of the current self-reported emotions will be repeated after every post-induction period (recovery ratings). Mixed models with individuals as random effect will be used to investigate the ratings at each stage of the study, taking into account the repeated measures of the same individuals at baseline, pre-induction, post-induction, and recovery. DISCUSSION: The study has potential to yield new insights into the role of vagal tone in emotion dysregulation in BPD and offer preliminary data on the effectiveness of taVNS as a possible non-invasive brain stimulation to treat a core symptom of BPD. TRIAL REGISTRATION: ClinicalTrials.gov NCT05892900. Retrospectively registered on Jun 07, 2023.

Elucidating the Onset of Cross-Protective Immunity after Intranasal Vaccination with the Attenuated African Swine Fever Vaccine Candidate BA71ΔCD2.

African swine fever (ASF) is a deadly disease of swine currently causing a worldwide pandemic, leading to severe economic consequences for the porcine industry. The control of disease spread is hampered by the limitation of available effective vaccines. Live attenuated vaccines (LAVs) are currently the most advanced vaccine prototypes, providing strong protection against ASF. However, the significant advances achieved using LAVs must be complemented with further studies to analyze vaccine-induced immunity. Here, we characterized the onset of cross-protective immunity triggered by the LAV candidate BA71ΔCD2. Intranasally vaccinated pigs were challenged with the virulent Georgia 2007/1 strain at days 3, 7 and 12 postvaccination. Only the animals vaccinated 12 days before the challenge had effectively controlled infection progression, showing low virus loads, minor clinical signs and a lack of the unbalanced inflammatory response characteristic of severe disease. Contrarily, the animals vaccinated 3 or 7 days before the challenge just showed a minor delay in disease progression. An analysis of the humoral response and whole blood transcriptome signatures demonstrated that the control of infection was associated with the presence of virus-specific IgG and a cytotoxic response before the challenge. These results contribute to our understanding of protective immunity induced by LAV-based vaccines, encouraging their use in emergency responses in ASF-affected areas.

A Serious Game for Cognitive Stimulation of Older People With Mild Cognitive Impairment: Design and Pilot Usability Study.

Background: Cognitive stimulation of older people helps prevent, and even treat, age-related diseases, such as mild cognitive impairment. Playing games reduces the probability of experiencing this pathology, which is related to the loss of the ability to carry out some instrumental activities of daily living. Objective: This work describes the design and development of a serious game for the cognitive stimulation of older people, with exercises related to the daily life task of shopping. A pilot study for its preliminary usability validation is also presented. Methods: The designed serious game includes 4 exercises consisting of shopping in a hypermarket, ordering products, making payments, and organizing the purchase, thus dealing with the most frequent cognitive problems of older people associated with episodic declarative memory, naming, calculation, and organization, respectively. Results: A total of 19 older people participated in the pilot study for the usability validation of the serious game. They indicated that they like the aesthetic and interesting topic of the game. They reported that it provides a high level of entertainment and could be useful in daily life for mental stimulation. The participants found the serious game to be intuitive, but the ease of use and readability of the instructions could be improved. Conclusions: This study suggests that the innovative serious game developed could be accepted by older people for their cognitive stimulation to prevent or treat mild cognitive impairment, although a long-term intervention study should be performed as future work. Its ecological validity design, with everyday tasks, adaptable levels of difficulty, and motivational mechanisms, is a differentiating factor compared to similar serious games.

Sequential RAS mutations evaluation in cell-free DNA of patients with tissue RAS wild-type metastatic colorectal cancer: the PERSEIDA (Cohort 2) study.

PURPOSE: RAS (KRAS/NRAS) mutational status on a tumor biopsy is mandatory to guide the best treatment in metastatic colorectal cancer (mCRC). Determining the RAS mutational status by tumor-tissue biopsy is essential in guiding the optimal treatment decision for mCRC. RAS mutations are negative predictive factors for the use of EGFR monoclonal antibodies. Cell-free DNA (cfDNA) analysis enables minimally invasive monitoring of tumor evolution. METHODS/PATIENTS: PERSEIDA was an observational, prospective study assessing cfDNA RAS, BRAF and EGFR mutations (using Idylla™) in first-line mCRC, RAS wild-type (baseline tumor-tissue biopsy) patients (cohort 2). Plasma samples were collected before first-line treatment, after 20 ± 2 weeks, and at disease progression. RESULTS: 117 patients were included (103 received panitumumab + chemotherapy as first-line treatment). At baseline, 7 (6.8%) patients had RAS mutations, 4 (3.9%) BRAF mutations and no EGFR mutations were detected (cfDNA, panitumumab + chemotherapy subpopulation [panitumumab + Ch]). The baseline RAS mutational status concordance between tissue and liquid biopsies was 94.0% (93.2%, panitumumab + Ch). At 20 weeks, only one patient in the study (included in the panitumumab + Ch) had an emerging cfDNA RAS mutation. No emerging BRAF or EGFR mutations were reported. At disease progression, 6 patients had emergent mutations not present at baseline (RAS conversion rate: 13.3% [6/45]; 15.0% [6/40], panitumumab + Ch). CONCLUSIONS: The concordance rate between liquid and solid biopsies at baseline was very high, as previously reported, while our results suggest a considerable emergence of RAS mutations during disease progression. Thus, the dynamics of the genomic landscape in ctDNA may provide relevant information for the management of mCRC patients.

A Computer Vision-Based System to Help Health Professionals to Apply Tests for Fall Risk Assessment.

The increase in life expectancy, and the consequent growth of the elderly population, represents a major challenge to guarantee adequate health and social care. The proposed system aims to provide a tool that automates the evaluation of gait and balance, essential to prevent falls in older people. Through an RGB-D camera, it is possible to capture and digitally represent certain parameters that describe how users carry out certain human motions and poses. Such individual motions and poses are actually related to items included in many well-known gait and balance evaluation tests. According to that information, therapists, who would not need to be present during the execution of the exercises, evaluate the results of such tests and could issue a diagnosis by storing and analyzing the sequences provided by the developed system. The system was validated in a laboratory scenario, and subsequently a trial was carried out in a nursing home with six residents. Results demonstrate the usefulness of the proposed system and the ease of objectively evaluating the main items of clinical tests by using the parameters calculated from information acquired with the RGB-D sensor. In addition, it lays the future foundations for creating a Cloud-based platform for remote fall risk assessment and its integration with a mobile assistant robot, and for designing Artificial Intelligence models that can detect patterns and identify pathologies for enabling therapists to prevent falls in users under risk.

A study protocol of a comparative mixed study of the T-Control catheter.

Background: Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. T-Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterization by a multifactorial approach. The general purpose of this study is to determine the effectiveness, comfort, and experience of the patient catheterized with T-Control® compared with patients with a conventional Foley catheter. Study Design: This trial is a mixed-method study comprising a two-arm, pilot comparative study with random allocation to T-Control catheter or traditional Foley catheter in patients with long-term catheterization and a study with qualitative methodology, through discussion groups. Endpoints: The comfort and acceptability of the T-Control® device (qualitative) and the quality of life related to self-perceived health (quantitative) will be analysed as primary endpoints. As secondary endpoints, the following will be analysed: magnitude and rate of infections (symptomatic and asymptomatic); days free of infection; indication of associated antibiotic treatments; determination of biofilm; number of catheter-related adverse events; use of each type of catheterization's healthcare resources; and level of satisfaction and workload of health professionals. Patients and Methods: Eligible patients are male and female adults aged ≥18 years, who require a change of long-term bladder catheter. The estimated sample size is 50 patients. Patient follow-up includes both the time of catheter insertion and its removal or change 4 weeks later, plus the time until the discussion groups take place.

Effectiveness of the T-Control catheter: A study protocol.

Background: Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. T-Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterisation by a multifactorial approach. The general purpose of this study is to evaluate the effectiveness and cost-effectiveness of the T-Control catheter versus the Foley-type catheter in patients with Acute Urine Retention (AUR). Study design: This is a pragmatic, open, multicentre, controlled clinical trial with random allocation to the T-Control catheter or a conventional Foley-type catheter in patients with AUR. Endpoints: The magnitude of infections will be analysed as a primary endpoint. While as secondary endpoint, the following will be analysed: rate of symptomatic and asymptomatic infections; days free of infection; quality of life-related to self-perceived health; indication of associated antibiotic treatments; determination of biofilm; number of catheter-related adverse events; use of each type of catheterisation's healthcare resources; level of satisfaction and workload of health professionals and acceptability of the T-Control device as well as the patient experience. Patients and methods: Eligible patients are male adults aged ≥50 years, with AUR and with an indication of bladder catheterisation for at least 2 weeks. The estimated sample size is 50 patients. Patient follow-up includes both the time of catheter insertion and its removal or change 2 weeks later, plus 2 weeks after this time when the patient will be called for an in-depth interview.

[Initial assessment of immigrant patients in primary care]. / Atención inicial al paciente inmigrante en atención primaria.

The clinical interview of immigrant patients requires cultural competence to ensure good understanding and correct communication, in addition to collecting specific information that differs from that of native patients, such as origin and migratory route or cultural identity. Screening for latent tuberculosis infection is recommended in certain cases and screening for other infections, both cosmopolitan with a higher prevalence in migrants (HIV, syphilis, hepatitis B and C) and imported (Chagas, intestinal parasites, strongyloidiasis, schistosomiasis), depending on origin. It is essential to check the vaccination status and complete the vaccination schedule, adapting it to the current calendar, prioritizing vaccines such as measles, rubella and poliomyelitis. We propose preventive activities to be carried out when traveling to countries of origin, due to their special characteristics and risks: general advice, exploring the risk of malaria, assessing specific vaccinations, advice regarding sexually transmitted infections and special considerations if they have chronic diseases; and addressing, if appropriate, the risks of female genital mutilation.

Bioabsorbable Composites Based on Polymeric Matrix (PLA and PCL) Reinforced with Magnesium (Mg) for Use in Bone Regeneration Therapy: Physicochemical Properties and Biological Evaluation.

Improvements in Tissue Engineering and Regenerative Medicine (TERM)-type technologies have allowed the development of specific materials that, together with a better understanding of bone tissue structure, have provided new pathways to obtain biomaterials for bone tissue regeneration. In this manuscript, bioabsorbable materials are presented as emerging materials in tissue engineering therapies related to bone lesions because of their ability to degrade in physiological environments while the regeneration process is completed. This comprehensive review aims to explore the studies, published since its inception (2010s) to the present, on bioabsorbable composite materials based on PLA and PCL polymeric matrix reinforced with Mg, which is also bioabsorbable and has recognized osteoinductive capacity. The research collected in the literature reveals studies based on different manufacturing and dispersion processes of the reinforcement as well as the physicochemical analysis and corresponding biological evaluation to know the osteoinductive capacity of the proposed PLA/Mg and PCL/Mg composites. In short, this review shows the potential of these composite materials and serves as a guide for those interested in bioabsorbable materials applied in bone tissue engineering.

Metastable FeMg particles for controlling degradation rate, mechanical properties, and biocompatibility of Poly(l-lactic) acid (PLLA) for orthopedic applications.

Poly(l-lactic) acid (PLLA) is commonly used in bioabsorbable medical implants, but it suffers from slow degradation rate and rapid decline in mechanical properties for orthopedic applications. To address this drawback, recent research has explored the use of Mg as a filler for PLLA, resulting in composites with improved degradation rate and cytocompatibility compared to neat PLLA. In this study, FeMg powder particles were proposed as fillers for PLLA to investigate the potential of PLLA/FeMg composites for bioabsorbable implants. Cylinder specimens of PLLA, PLLA/Fe, PLLA/Mg and PLLA/FeMg were prepared using solvent casting followed by thermo-molding. The microstructure, thermal behavior, in vitro degradation behavior in simulated body fluid, mechanical properties and cytocompatibility of these composites were examined. The results indicate that the presence of FeMg particles prevents the deterioration of the composite mechanical properties, at least up to 14 days. Once a certain amount of degradation of the composite is reached, the degradation is faster than that of PLLA. Direct cytotoxicity assays revealed that pre-osteoblast MC3T3-E1 cells successfully adhered to and proliferated on the PLLA/FeMg surface. The inclusion of a low percentage of Mg into the Fe lattice not only accelerated the degradation rate of Fe but also improved its cytocompatibility. The enhanced degradation rate, mechanical properties, and osteoconductive properties of this composite make it a promising option for temporary orthopedic biomedical devices.

Prevalencia de Sars-CoV-2 en los profesionales sanitarios de un servicio hospitalario de pediatría / Prevalence of SARS-CoV-2 in health professionals of a hospital pediatric service

La enfermedad por SARS-CoV-2 (COVID-19), declarada pandemia mundial en marzo de 2020, ha afectado a millones de personas en todo el mundo, siendo los profesionales sanitarios uno de los colectivos más expuestos. El objetivo del presente estudio es analizar la prevalencia de la infección por SARS-CoV-2 en los profesionales sanitarios de un área determinada de un hospital terciario durante la primera ola de la pandemia COVID-19 en España. Material y métodos: Se realizó un estudio observacional de tipo transversal, mediante la autocumplimentación de una encuesta voluntaria y anónima por parte de los profesionales sanitarios de los servicios de Pediatría y Maternidad del Hospital Clínico Universitario de Valladolid (HCUV). La encuesta recogió información del período comprendido entre el 10 de marzo y 15 de junio de 2020. Resultado: Participaron en el estudio 177 profesionales de los 231 trabajadores totales en plantilla lo que supuso una participación del 76,6%. Fueron diagnosticadas 37 personas de infección por SARS-CoV-2: 25 personas mediante técnica de Reacción en Cadena de la Polimerasa con Transcriptasa Inversa (RT-PCR) y 12 mediante pruebas serológicas (ELISA). La prevalencia global de infección por SARS-CoV-2 fue de 20,9% y requirieron ingreso hospitalario 3 personas. Conclusión: La prevalencia de infección por SARS-CoV-2 durante la primera ola de la pandemia en el personal sanitario del Servicio de Pediatría y Maternidad del HCUV fue superior a la declarada por la Red de Vigilancia Epidemiológica de Castilla y León. Uno de cada 5 profesionales de la salud del presente estudio ha tenido la infección por SARS-CoV-2. (AU)

SARS-CoV-2 disease (COVID-19), declared a global pandemic in March 2020, has affected millions of people worldwide, with healthcare professionals being one of the most exposed groups. The aim of this study was to analyze the prevalence of SARS-CoV-2 infection in healthcare professionals in a specific area of a tertiary hospital during the first wave of the COVID-19 pandemic in Spain. Material and methods: A transversal observational study was carried out by means of a voluntary and anonymous self-completion survey by healthcare professionals from the Pediatrics and Maternity services of the Hospital Clínico Universitario de Valladolid (HCUV). The survey collected information from the period between 10 March and 15 June 2020. Results: 177 professionals of the 231 total staff participated in the study, which meant a participation rate of 76.6%. SARS-CoV-2 infection was diagnosed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in 25 persons and by serological tests (ELISA) in 12 persons. The overall prevalence of SARS-CoV-2 infection was 20.9% and 3 persons required hospital admission. Conclusion: The prevalence of SARS-CoV-2 infection during the first wave of the pandemic among healthcare personnel in the Pediatrics and Maternity Department of the HCUV was higher than that reported by the Epidemiological Surveillance Network of Castilla y León. One in 5 healthcare professionals in the present study had been infected with SARS-CoV-2. (AU)

Efectividad de los cambios posturales en la prevención de lesiones por presión en pacientes de atención primaria y domiciliaria / Effectiveness of postural changes in the prevention of pressure injuries in primary and home care patients

Objetivos: Analizar la eficacia de los cambios posturales en la prevención de lesiones por presión en atención primaria y sociosanitaria. Metodología: Se ha realizado una revisión sistemática de la literatura en bases de datos como MEDLINE (PubMed), SciELO, TSEO y Google Académico. También se ha extraído información de repositorios universitarios. Los artículos seleccionados son revisiones sistemáticas, ensayos clínicos y una revisión histórica. Resultados: Se encontraron un total de 568 artículos, de los cuales 15 cumplieron los criterios de inclusión. Los ensayos clínicos aleatorios incluidos se realizaron en residencias de ancianos u hospitales de larga estancia. Conclusiones: La frecuencia de cambios posturales implica gran controversia. No obstante, la menor incidencia de úlceras por presión se relaciona con cambios posturales cada 3 h y con colchones viscoelásticos (AU)

Objectives: To analyze the efficacy of postural changes in the prevention on pressure injuries in primary and socio-health care. Methodology: A systematic review of the literatura has been carried out in databases: MEDLINE (PubMed), SciELO, TSEO and Google Academy. Information has also been extracted from university repositories. The selected articles are systematic reviews, clinical trials and a historical review. Results: A total of 568 articles were found, of which 15 met the inclusion criteria. Included randomized clinical trials were condcuted in nursing home or long-stay hospitals. Conclusions: The frequency of postural changes implies great controversy. Nevertheless, the lower incidence of pressure ulcers is related to postural changes every 3 h and to viscoelastic mattresses (AU)

Historia de la Cirugía General en Cuba y el mundo

RESUMEN Introducción: La cirugía es tan antigua como la historia de la humanidad, se remonta a los tiempos más lejanos cuando el hombre hace su aparición en el teatro de la historia, a raíz de la individualidad física, psíquica y social. Objetivo: Abordar aspectos importantes de la historia de la Cirugía General desde la antigüedad hasta la actualidad y su desarrollo en Cuba. Método: Se realizó una revisión bibliográfica en la base de datos de la National Library of Medicine, PubMed, Google Académico, Web of Science, ClinicalKey, Elsevier, ResearchGate y páginas web de distintas especialidades que recomendaron artículos de interés en relación al tópico para la reconstrucción del surgimiento de la cirugía desde la antigüedad hasta la actualidad. Resultados: Se recopilaron apuntes cronológicos divididos en: La cirugía en la antigüedad, América precolombina, La Edad Media y el Renacimiento, Desarrollo de la cirugía general en Cuba (breve recorrido 1354 hasta la actualidad). Consideraciones finales: El desarrollo de la cirugía comienza desde la antigüedad como necesidad, la especialización de los cirujanos generales en Cuba comienza a partir del siglo XVIII, cuando se separa de la cátedra de Anatomía para hacer la disciplina quirúrgica, lo cual ha tenido un progreso mantenido a lo largo de la historia, cuya magnitud es consecuente con el grado de desarrollo de la sociedad y de las limitaciones externas e internas, lo que se considera como un hito en el desarrollo de esta especialidad hasta la actualidad, con avances científicos, técnicos y anestésicos quirúrgicos de lo cual Cuba hoy exhibe a nivel mundial.

ABSTRACT Introduction: Surgery is as old as the history of humanity. It goes back to the most distant times when man made his appearance, as a result of physical, mental and social individuality. Objective: To approach important aspects of the history of General Surgery from ancient times to the present and its development in Cuba. Method: A bibliographic review was carried out in the database of the National Library of Medicine, PubMed, Google Scholar, Web of Science, ClinicalKey, Elsevier, ResearchGate and web pages of different specialties that recommended articles of interest in relation to the topic for research, to reconstruct the emergence of surgery from antiquity to the present day. Results: Chronological notes were compiled, divided into the next categories: Surgery in antiquity, pre-Columbian Americas, The Middle Ages and the Renaissance, Development of general surgery in Cuba (brief journey from 1354 to the present). Final considerations: The development of surgery begins from antiquity as a necessity; the specialization of general surgeons in Cuba begins in the eighteenth century, when it is separated from the Anatomy chair to perform as the surgical discipline, which has had a sustained progress throughout history. Its magnitude is consistent with the degree of development of society and society´s external and internal limitations. The development of this specialty in Cuba is considered a milestone, exhibiting high standards of scientific, technical and surgical-anesthetic advances today.

RESUMO Introdução: A cirurgia é tão antiga quanto a história da humanidade, remonta aos tempos mais distantes em que o homem faz sua aparição no teatro da história, fruto da individualidade física, mental e social. Objetivo: Tratar aspectos importantes da história da Cirurgia Geral desde a antiguidade até o presente e seu desenvolvimento em Cuba. Método: Foi realizada revisão bibliográfica na base de dados da National Library of Medicine, PubMed, Google Scholar, Web of Science, ClinicalKey, Elsevier, ResearchGate e páginas da web de diferentes especialidades que recomendavam artigos de interesse em relação ao tema para pesquisa reconstrução do surgimento da cirurgia desde a antiguidade até o presente. Resultados: Foram compiladas notas cronológicas divididas em: Cirurgia na antiguidade, América pré-colombiana, Idade Média e Renascimento, Desenvolvimento da cirurgia geral em Cuba (breve viagem de 1354 até o presente). Considerações finais: O desenvolvimento da cirurgia começa desde a antiguidade como uma necessidade, a especialização dos cirurgiões gerais em Cuba começa no século XVIII, quando se separa da cadeira de Anatomia para fazer a disciplina cirúrgica, que teve um progresso mantido ao longo da história , cuja magnitude é compatível com o grau de desenvolvimento da sociedade e limitações externas e internas, que é considerado um marco no desenvolvimento desta especialidade até hoje, com anestésicos científicos, técnicos e cirúrgicos que Cuba hoje exibe em todo o mundo.

Desarrollo de las habilidades profesionales del cirujano general en la atención preoperatoria mediata / Development of the general surgeon professional skills in the mediate preoperative care

Introducción: El avance en los disímiles tratamientos y habilidades profesionales en torno a la intervención quirúrgica en el continente americano va aparejado al desarrollo que existe en Europa, y Cuba no queda exenta de los progresos alcanzados hasta la actualidad. Objetivo: Diagnosticar las insuficiencias en el desarrollo de las habilidades profesionales de los cirujanos generales, en la atención preoperatoria mediata. Métodos: Se realizó una investigación cuasi - experimental de 60 médicos especialistas y residentes, encargados de la atención preoperatoria mediata en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde diciembre de 2019 hasta mayo de 2021, para lo cual se conformaron 2 grupos: A (de estudio) y B (de control), con 30 integrantes cada uno. Se analizaron las variables seleccionadas y se definieron las dimensiones para demostrar la correspondencia con los indicadores de dichas variables. Resultados: Existió un predominio del sexo masculino en ambos grupos y de las edades entre 15 - 44 años (83,3 % en el grupo A y 90,0 % en el B). Las dimensiones más afectadas en orden decreciente fueron: superación, cognitiva, científico - investigativa y axiológica. La triangulación de los instrumentos arrojó que la variable desempeño profesional se encontraba con un nivel de afectación alto. Conclusiones: Las indagaciones teóricas y empíricas para la caracterización del estado actual de los cirujanos generales permitieron determinar, que existían insuficiencias en todas las dimensiones exploradas, lo cual dificultó el desarrollo de las habilidades profesionales relacionadas con la atención preoperatoria mediata.

Introduction: The advance in the dissimilar treatments and professional skills around the surgical intervention in the American continent goes together with the development that exists in Europe, and Cuba is not exempt of the progresses reached until the present time. Objective: To diagnose the inadequacies in the development of the general surgeons professional skills, in the mediate preoperative care. Methods: A quasi-experimental investigation of 60 specialist doctors and residents, in charge of the mediate preoperative care was carried out in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital from Santiago de Cuba, from December, 2019 to May, 2021, for which 2 groups were conformed: A (study group) and B (control group), with 30 members each one. The selected variables were analyzed and the dimensions to demonstrate the correspondence with the indicators of these variables were defined. Results: There was prevalence of the male sex in both groups and the 15 - 44 age group (83.3 % in group A and 90.0 % in group B). The most affected dimensions in decreasing order were: training, cognitive, scientific - investigative and axiological. The triangulation of the instruments showed that the variable professional performance was in a high level of affectation. Conclusion: The theoretical and empiric investigations for the characterization of the current state of the general surgeons allowed to determine that inadequacies existed in all the explored dimensions, which made difficult the development of the professional skills related to the mediate preoperative care.

Efecto de los polimorfismos en UGT, SLCO, ABCB y ABCC en la toxicidad del tratamiento con irinotecán / Effect of UGT, SLCO, ABCB and ABCC polymorphisms on irinotecan toxicity

Antecedentes y objetivos: Evaluar la relación entre la presencia de polimorfismos en los genes implicados en la farmacodinamia del irinotecán (UGT1A, SLCO1B1, ABCB1 y ABCC2) y la seguridad asociada al mismo en el tratamiento del cáncer colorrectal metastásico (CCRm). Pacientes y métodos: Estudio prospectivo observacional y unicéntrico de 30 meses de duración, en el que se incluyeron los pacientes diagnosticados de CCRm tratados con el esquema FOLFIRI. La toxicidad fue evaluada en cada ciclo de tratamiento según la Common Terminology Criteria for Adverse Events (CTCAE) v.4.0 NCI. La obtención del ADN genómico se realizó mediante una muestra de sangre periférica a partir de un método de extracción basado en lisis alcalina. La caracterización genética se realizó empleando la plataforma LigthCycler®480 y sondas fluorescentes HybProbe® específicas de alelo. Los polimorfismos analizados fueron: UGT1A1*28, UGT1A1*60, UGT1A7*1,*2,*3,*4, UGT1A7*12, UGT1A9*22, SLCO1B1 (rs11045879), ABCC2 (rs717620) y ABCB1 (rs1045642). Resultados: Fueron incluidos 34 pacientes (el 73,5% eran hombres, con una edad media de 59,9 años [27-81]). Los polimorfismos: rs8175347, rs17868323, rs3832043, rs11692021 y rs7577677 se relacionaron con una mayor incidencia de efectos adversos. Por otro lado, se observó que aquellos pacientes wild-type, en la serie de genes de la familia UGT analizada, presentan unas menores tasas de toxicidad asociada al tratamiento con irinotecán que aquellos que poseen alguno de los polimorfismos analizados (p=0,010). Conclusiones: Estos resultados sugieren que la presencia de determinados polimorfismos en la familia de genes UGT1A se encuentra relacionada con el desarrollo de toxicidad en el tratamiento con irinotecán en dosis para el esquema FOLFIRI

Background and objectives: Evaluate the relationship between the presence of polymorphisms in genes involved in the pharmacodynamics of irinotecan (UGT1A, SLCO1B1, ABCB1 and ABCC2) and the safety of irinotecan in the treatment of metastatic colorectal cancer (mCRC). Patients and methods: Prospective observational, single-centre study of 30 months duration, which included patients diagnosed with mCRC treated with FOLFIRI was carried out. Toxicity was evaluated in each treatment cycle according to the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0 NCI. Genomic DNA was obtained with a peripheral blood sample from an extraction method based on alkaline lysis. Genetic characterisation was performed using the LigthCycler®480 platform and allele-specific HybProbe® fluorescent probes. Analysed polymorphisms were: UGT1A1*28, UGT1A1*60, UGT1A7*1,*2,*3,*4, UGT1A7*12, UGT1A9*22, SLCO1B1 (rs11045879), ABCC2 (rs717620) and ABCB1 (rs1045642). Results: Thirty-four patients were included (73.5% were male, mean age 59.9 years [27-81]) in the study. Polymorphisms rs8175347, rs17868323, rs3832043, rs11692021 and rs7577677 were associated with a higher incidence of adverse effects. Furthermore, it was observed that those patients with wild-type in UGT family genes analysed have lower rates of toxicity associated with irinotecan treatment than those with certain mutated allele (P=.010). Conclusions: These results suggest that the presence of certain polymorphisms in the UGT1A family of genes is related to the development of toxicity during treatment with irinotecan

Inserción de prótesis pancreáticas tras la canulación involuntaria con guía del Wirsung en la CPRE / Pancreatic stent insertion after an unintentional guidewire cannulation of the pancreatic duct during ERCP

Introducción: en los intentos de canulación del colédoco durante la colangiopancreatografía retrógrada endoscópica (CPRE) la guía puede entrar en el conducto pancreático. No está definido qué maniobra es más eficaz para canular la vía biliar y prevenir la pancreatitis tras pasar la guía al Wirsung. Objetivo: estudiar la tasa de canulación coledociana y de pancreatitis post-CPRE cuando en la primera ocasión en que la guía pasó al conducto pancreático de forma involuntaria se insertó una prótesis pancreática. Material y métodos: análisis retrospectivo de pacientes a los que se realizó una CPRE para drenaje biliar e incluidos de forma prospectiva en una base de datos. Tras la inserción involuntaria de una guía en el conducto pancreático se insertó una prótesis plástica recta de 5 Fr y 4 cm de longitud, sin topes internos para facilitar su expulsión. El colédoco se intentó canular por encima de la prótesis. En los pacientes mayores de 60 años se realizó una esfinterotomía pancreática antes de insertar la prótesis. Resultados: en un grupo de 154 CPRE se insertaron 46 prótesis pancreáticas (29,8%) y en estos casos el colédoco se canuló en el 95,6% (44/46) de las ocasiones. Se realizaron 21/46 (45,6%) esfinterotomías pancreáticas. Hubo 1/46 (2,17%) pancreatitis leves. La mayoría de las prótesis se expulsaron de forma espontánea. Conclusiones: en este estudio, la inserción de una prótesis pancreática plástica cuando la guía ha pasado al conducto pancreático de forma involuntaria en los intentos de canulación del colédoco ayudó a canular la vía biliar en la mayoría de las ocasiones, sin que la inserción de las prótesis produjera efectos adversos

Introduction: the guidewire (GW) may enter the pancreatic duct during common bile duct (CBD) cannulation attempts in endoscopic retrograde cholangiopancreatography (ERCP). After GW passage into the pancreas, the most effective maneuver for CBD cannulation and pancreatitis prevention has not been determined. Aim: to study CBD cannulation and post-ERCP pancreatitis rates when a pancreatic stent is inserted after an unintentional GW cannulation of the pancreatic duct. Material and methods: a retrospective analysis of patients undergoing ERCP for biliary drainage that were included prospectively into a database. After unintentional GW cannulation of the pancreatic duct, a straight 5-Fr and 4-cm long plastic stent was inserted. The stents had no internal flaps to facilitate expulsion. CBD cannulation attempts were made above the stent. A pancreatic sphincterotomy was performed in patients older than 60 years before stent insertion. Results: a total of 46 pancreatic stents were inserted during 154 ERCP (29.8%) procedures. In the stent group, CBD cannulation was accomplished in 44/46 (95.6%) subjects. A total of 21/46 (45.6%) pancreatic sphincterotomies were performed. Only 1/46 (2.17%) mild pancreatitis cases were observed and most stents were spontaneously expelled. Conclusions: in this study, the CBD was eventually reached with the insertion of a plastic pancreatic stent after an unintentional GW passage into the pancreatic duct while attempting a CBD cannulation. No adverse events were observed following pancreatic stent insertion

Vía clínica del cólico nefrítico / No disponible

El cólico nefrítico es un proceso frecuente en un servicio de urgencias y su tratamiento no solo se enfoca al alivio del dolor, sino a la desobstrucción de la vía urinaria. La litogénesis depende de factores étnicos, geográficos (mayor prevalencia a mayor nivel de vida) (1), dietéticos y genéticos, y su riesgo de recurrencia es determinado por enfermedades causantes de la misma. En Europa y EEUU, la prevalencia estimada ha sido del 15-13 por mil (2), con un pico de máxima frecuencia entre la tercera y la quinta década de la vida (3). Se puede hablar de prioridades en la actuación sobre este proceso. La primera es establecer el diagnóstico a través de la realización de diferentes tipos de test. La segunda es el tratamiento del dolor agudo. La tercera es, una vez estabilizado el paciente, valorar la actitud a seguir, es decir ingreso o derivación a consulta especializada al alta. Aunque el personal sanitario conoce los diferentes pasos a seguir ante un paciente con cólico nefrítico, la literatura arroja ,por ejemplo, diferentes criterios en la realización de test diagnósticos, de los que hasta 1/3 puede ser total o parcialmente injustificado (4).Asimismo, solo un 21,3 por mil de médicos prescribe alfa-bloqueantes (5) o recomiendan la ingesta de más de 500 cc de líquidos (aun cuando un metaanálisis ha demostrado que no tiene efecto sobre el paso de litiasis por el uréter) (6). Por lo tanto, la necesidad de protocolización de este proceso es evidente en todos los estamentos sanitarios, desde un adecuado triaje de enfermería (7) hasta un juicioso empleo de test diagnósticos y tratamientos, así como un correcto plan terapéutico a seguir tras la atención del paciente en el servicio de urgencias. Presentamos una vía clínica del proceso cólico nefrítico, desarrollada principalmente con un objetivo claro, el paciente, eje de todas las actuaciones sanitarias que se van a desarrollar en torno a él. Realizamos previamente revisión de las evidencias clínicas disponibles tras análisis de la situación en nuestro medio

Renal colic is a common complaint observed in the emergency room and its treatment not only focus on pain relief but also on desobstruction of the urinary tract. The lithogenesis depends on ethnic, geographic, dietetic and genetic factors as well as its recurrence risk. The latter is determined by diseases responsible for the lithogenesis. The estimated prevalence has been 15-13 per-mille in Europe and USA, with a peak incidence between the third and the fifth decade of life. Regarding this process we can distinguish four priorities. Firstly, to establish the diagnosis associated with the realization of different types of tests. Secondly, treatment for acute pain. Thirdly, to value the steps to follow, that is to say, admission or derivation after discharge from hospital. There are different criteria with regards to the realization of diagnostic tests. The analysis of the results shows that 1/3 can be total or partially not justified. Additionally, only 21.3 per-mille of the doctors prescribe blocker or recommend a fluid intake of more than 500 cc (although there is no evidence of benefits). Therefore, it is necessary to protocolize this process from an appropriate triage nursing to a value judgment of tests and treatment as well as a correct therapeutic plan to follow after the patient has been attended in the emergency room. A clinical pathway for renal colic is presented. It has been developed with a clear objective, the patient is at the centre of action plan for healthcare. Revisions of clinical evidences have been conducted before hand

¿Puede ser una apendicitis aguda la primera manifestación de endometriosis? / Can acute appendicitis be the first manifestation of endometrial disease?

Objetivo. Demostrar la relación entre la afectación endometriósica del apéndice cecal y el desarrollo de una apendicitis aguda. Pacientes y métodos. Presentamos una serie institucional de 8 pacientes con endometriosis apendicular diagnosticadas tras apendicectomía entre junio de 2009 y marzo de 2014. Resultados. La media de edad fue 40,6 años, 6 en edad fértil. En 5 (62,5%) la afectación endometriósica apendicular resultó única y en 3 (37,5%) múltiple, fundamentalmente en el ovario. Siete (87,5%) iniciaron los síntomas como una apendicitis aguda. Los implantes endometriósicos afectaban la capa serosa en 6 pacientes, la capa muscular en una y la grasa periapendicular en otra. Conclusión. El diagnóstico de endometriosis apendicular en mujeres con apendicitis aguda solo se puede realizar tras el examen de las piezas de apendicectomía, aunque puede ser sospechado en el contexto clínico. La laparoscopia permite un diagnóstico adecuado con exploración completa de la pelvis, la apendicectomía y el tratamiento de otras lesiones (AU)

Aim. To determine the relationship between endometriotic involvement of the appendix and the development of acute appendicitis. Patients and methods. We report a series of 8 patients with appendiceal endometriosis diagnosed after appendicectomy from June 2009 to March 2014. Results. The mean age was 40.6 years. Six patients were of reproductive age. Endometriotic appendiceal involvement alone was found in 5 patients (62.5%) and multiorgan involvement, mainly affecting the ovary, in 3 patients (37.5%). Clinical presentation was acute appendicitis in 7 patients (87.5%). Endometriotic implants involved the serous layer in 6 patients, the muscle layer in one patient, and periappendiceal fat in another patient. Conclusion. Diagnosis of appendiceal endometriosis in women with acute appendicitis can only be performed after specimen study, although it may be suspected in the clinical context. Laparoscopy allows pelvic and abdominal cavity examination, appendectomy, and the treatment of other lesions (AU)