ABSTRACT
BACKGROUND: The management of a vascular injury during cholecystectomy is still very complicated, especially in centers not specialized in complex hepatobiliary surgery. METHODS: This was a multi-institutional retrospective study in patients with vascular injuries during cholecystectomy from 18 centers in 4 countries. The aim of the study was to analyze the management of vascular injuries focusing on referral, time to perform the repair, and different treatments options outcomes. RESULTS: A total of 104 patients were included. Twenty-nine patients underwent vascular repair (27.9%), 13 (12.5%) liver resection, and 1 liver transplant as a first treatment. Eighty-four (80.4%) vascular and biliary injuries occurred in nonspecialized centers and 45 (53.6%) were immediately transferred. Intraoperative diagnosed injuries were rare in referred patients (18% vs 84%, P = .001). The patients managed at the hospital where the injury occurred had a higher number of reoperations (64% vs 20%, P Ë .001). The need for vascular reconstruction was associated with higher mortality (P = .04). Two of the 4 patients transplanted died. CONCLUSION: Vascular lesions during cholecystectomy are a potentially life-threatening complication. Management of referral to specialized centers to perform multiple complex multidisciplinary procedures should be mandatory. Late vascular repair has not shown to be associated with worse results.
Subject(s)
Cholecystectomy, Laparoscopic , Vascular System Injuries , Bile Ducts/surgery , Cholecystectomy/adverse effects , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/epidemiology , Intraoperative Complications/etiology , Reoperation , Retrospective Studies , Vascular System Injuries/diagnosis , Vascular System Injuries/etiology , Vascular System Injuries/surgeryABSTRACT
BACKGROUND: Iatrogenic bile duct injury (IBDI) is a challenging surgical complication. IBDI management can be guided by artificial intelligence models. Our study identified the factors associated with successful initial repair of IBDI and predicted the success of definitive repair based on patient risk levels. METHODS: This is a retrospective multi-institution cohort of patients with IBDI after cholecystectomy conducted between 1990 and 2020. We implemented a decision tree analysis to determine the factors that contribute to successful initial repair and developed a risk-scoring model based on the Comprehensive Complication Index. RESULTS: We analyzed 748 patients across 22 hospitals. Our decision tree model was 82.8% accurate in predicting the success of the initial repair. Non-type E (p < 0.01), treatment in specialized centers (p < 0.01), and surgical repair (p < 0.001) were associated with better prognosis. The risk-scoring model was 82.3% (79.0-85.3%, 95% confidence interval [CI]) and 71.7% (63.8-78.7%, 95% CI) accurate in predicting success in the development and validation cohorts, respectively. Surgical repair, successful initial repair, and repair between 2 and 6 weeks were associated with better outcomes. DISCUSSION: Machine learning algorithms for IBDI are a novel tool may help to improve the decision-making process and guide management of these patients.
Subject(s)
Abdominal Injuries , Bile Duct Diseases , Cholecystectomy, Laparoscopic , Abdominal Injuries/surgery , Artificial Intelligence , Bile Ducts/injuries , Bile Ducts/surgery , Cholecystectomy/adverse effects , Cholecystectomy, Laparoscopic/adverse effects , Humans , Iatrogenic Disease , Intraoperative Complications/surgery , Machine Learning , Retrospective StudiesABSTRACT
BACKGROUND: Treatment and outcome of Candida spp infectious endocarditis in children it most be based on treatment guidelines, however there are some controversies. AIM: To describe our experience on treatment of pediatric candidal infective endocarditis. METHODS: Analytic prospective study, from January 2006 to December 2017. Parametric analysis for quantitative variable. Proportions were compared by χ2 and exact Fisher Test CI 95%. Mortality rate. RESULTS: 25 episodes of Candida spp infective endocarditis were treated with standard antifungal drugs. Mortality rate was higher on patients submited to endocardic vegetation resection (66.7%) RR= 3.16, (χ2 p = 0.029), children with lymphohemophagocytic syndrome (LHFS) (50 %) RR= 1.18 (χ2 = N.S.), in multidrug resistant bacterial co infection (57.14%), RR = 2, (χ2 = NS) also thrombotic endocarditis (88.9%) RR= 4.74 (χ2 p = 0.004). CONCLUSION: Multidrug resistant bacteria co infection with Candida sp IE, LHFS, and/or surgical treatment of endocardic vegetation, might be considered as bad prognostic factors.
Subject(s)
Candida/classification , Candidiasis/microbiology , Endocarditis, Bacterial/microbiology , Adolescent , Candidiasis/mortality , Candidiasis/therapy , Child , Child, Preschool , Endocarditis, Bacterial/mortality , Endocarditis, Bacterial/therapy , Female , Humans , Infant , Infant, Newborn , Male , Prospective Studies , Risk FactorsABSTRACT
Resumen Introducción: El tratamiento y evolución de endocarditis infecciosa por Candida spp en niños debe basarse en guías de manejo; sin embargo, aún existen controversias al respecto. Objetivo: Describir nuestra experiencia en el tratamiento de EI por Candida spp en pacientes pediátricos. Métodos: Estudio prospectivo, analítico, realizado entre enero de 2006 y diciembre 2017. Análisis paramétrico de variables cuantitativas; razones, proporciones, comparación por medio de χ2 y prueba exacta de Fisher con IC al 95% para variables no paramétricas. Tasa de mortalidad. Resultados: Veinticinco episodios de endocarditis por Candida spp recibieron tratamiento anti fúngico estándar. La mortalidad fue superior en pacientes sometidos a resección de la vegetación endocárdica (66,7%) RR 3,16, χ2 p = 0,029, en niños con síndrome linfo-hemofagocítico SLHF (50%), RR= 1,18 (χ2 NS), en co infección con bacterias multi-resistentes (57,1 %) RR= 2, (χ2 NS) y en EI trombótica (88,9%) RR = 4,74 (χ2 p = 0,004). Conclusiones: Co-infección de EI por Candida sp con bacterias multi-resistentes, SLHF y/o manejo quirúrgico de la vegetación endocárdica, pueden considerarse factores de mal pronóstico.
Background: Treatment and outcome of Candida spp infectious endocarditis in children it most be based on treatment guidelines, however there are some controversies. Aim: To describe our experience on treatment of pediatric candidal infective endocarditis. Methods: Analytic prospective study, from January 2006 to December 2017. Parametric analysis for quantitative variable. Proportions were compared by χ2 and exact Fisher Test CI 95%. Mortality rate. Results: 25 episodes of Candida spp infective endocarditis were treated with standard antifungal drugs. Mortality rate was higher on patients submited to endocardic vegetation resection (66.7%) RR= 3.16, (χ2 p = 0.029), children with lymphohemophagocytic syndrome (LHFS) (50 %) RR= 1.18 (χ2 = N.S.), in multidrug resistant bacterial co infection (57.14%), RR = 2, (χ2 = NS) also thrombotic endocarditis (88.9%) RR= 4.74 (χ2 p = 0.004). Conclusion: Multidrug resistant bacteria co infection with Candida sp IE, LHFS, and/or surgical treatment of endocardic vegetation, might be considered as bad prognostic factors.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Candida/classification , Candidiasis/microbiology , Endocarditis, Bacterial/microbiology , Candidiasis/mortality , Candidiasis/therapy , Prospective Studies , Risk Factors , Endocarditis, Bacterial/mortality , Endocarditis, Bacterial/therapyABSTRACT
El perfeccionamiento del modo de actuación profesional del docente para la dirección del proceso pedagógico integrado y desarrollador, constituye un compromiso ético para el logro de la educación en Ciencia, Tecnología y Sociedad en la Educación Médica Superior. Los marcos conceptuales con los que operaban en el pasado, las políticas científico-tecnológicas y las educativas, deben ser sustituidos por ideas contemporáneas; se requiere la comprensión de los procesos de innovación social, por lo que se considera de gran importancia la enseñanza de las características culturales de la ciencia médica, sus rasgos epistemológicos, los conceptos éticos que la envuelven y la interacción de estos con la sociedad (AU)
The improvement of the way of professional performance of teachers for the direction of developer and integrated pedagogical process, constitutes an ethical commitment for the achievement of education in science, Technology and Society in the Superior Medical Education. The conceptual marks which they operated in the past, the scientific-techonologic politics and the educative ones, must be replaced by contemporary ideas, the understanding of the social innovation processes is required, reason why it considers a great importance the education of the cultural characteristics of medical science, its epistemologic characteristics, the ethical concepts that surround it and their interaction with the society (AU)
Subject(s)
Science, Technology and Society , Education, Medical , Review Literature as TopicABSTRACT
Se realizó un estudio de intervención , en el personal de salud que participó en la atención médica a los pacientes afectados por Dengue que se encontraban ingresados en los Hospitales de Campaña creados en la Provincia Ciego de Ávila en los meses de Septiembre y Octubre del año 2006, aplicando técnicas de revisión documental en Historias Clínicas Individuales y entrevistas efectuadas tanto al personal de salud como a pacientes y familiares, detectando dificultades en el manejo con estos pacientes y falta de responsabilidad de la población en general ante las principales medidas de prevención de esta entidad, por lo que decidimos diseñar un Programa de Capacitación sobre Dengue, que incidiera en elevar el nivel de aprendizaje, posterior a esto pudimos apreciar que aumentó la calidad en la confección de las Historias Clínicas Individuales constatado por un equipo de revisión de este documento; también aumentó la responsabilidad de la población ante el riesgo de la epidemia pues se elevó la asistencia a consultas, puestos médicos, consultorios de personas ante síntomas sugestivos de Dengue, esto se constató en hojas de cargo y registros de consultas; también disminuyó el nivel de focos de mosquito en las viviendas constatado por las brigadas de lucha antivectorial y finalmente lográndose el control epidémico de esta patología(AU)
An intervention was carried out on the personnel worked with people infected with dengue in hospitals of Ciego de Avila during the months of september and october in the year 2006. Techniques of case histoires revision and interviews were applied to patients, relatives and health personnel. The study detected difficulties in patient management and lack of responsability on the part of the population concerning preventive measures to be taken, that is why we decided to devise the training program on dengue management. This brough about an improvement in the quality of case histories, confirmed by a revision team created with this as well as an improvement on the peoples responsabilities concerning the epidemic risks. There was more attendance to casualty departments, and family doctors consulting rooms by people with symptoms of denguesomething which was registered in the documents of these places. There was also a reduction in the mosquito population in houses according to different inspections carried out. Finally, it was posible to control the epidemi(AU)
Subject(s)
Humans , Male , Female , Dengue , Education , Health Personnel/educationABSTRACT
Objetivo: Evaluar la cumplimentación, tolerancia y eficacia de una pauta corta de quimioprofilaxis para tuberculosis con isoniacida y rifampicina durante 3 meses frente a una pauta estándar de isoniacida durante 12 meses en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Pacientes y métodos: Ensayo clínico prospectivo, comparativo, aleatorizado y abierto realizado en cuatro hospitales generales y un centro penitenciario de Castilla-La Mancha. La profilaxis se administró en pacientes PPD positivos y pacientes anérgicos de acuerdo con las normas de los Centers for Diseases Control (CDC) de 1991. Los pacientes se distribuyeron de forma aleatoria en dos pautas: pauta de rifampicina a los que se les administraron 300 mg/día de isoniacida y 600 mg/día de rifampicina durante 3 meses, y pauta de isoniacida a los que se les administraron 300 mg/día de isoniacida durante 12 meses. Resultados: Se incluyeron 133 pacientes: 64 en la pauta isoniacida y 69 en la pauta rifampicina. Se toleró mejor la pauta de rifampicina, con un 28 por ciento de efectos adversos frente a un 55 por ciento en la pauta de isoniacida. La hepatotoxicidad fue más frecuente en la pauta de isoniacida, con un riesgo relativo (RR) de 2,2 (intervalo de confianza [IC] del 95 por ciento, 1,23-4,01). La hepatotoxicidad grave, que obligó a suspender el tratamiento, se relacionó con el tiempo de administración del fármaco, siendo más frecuente en la pauta de 12 meses. Se cumplimentó mejor la pauta corta, pero sin diferencias valorables. La incidencia de tuberculosis fue de 4,23 casos por 100 personas-año para la pauta de isoniacida y 2,08 para la pauta de rifampicina, con un riesgo relativo para desarrollar tuberculosis con la pauta de rifampicina de 0,51 (IC del 95 por ciento, 0,09-2,8) frente a la pauta de isoniacida, no estadísticamente significativo. La estancia en prisión se asoció con un riesgo significativo de tuberculosis, independientemente de la pauta de tratamiento (RR = 9,2; IC del 95 por ciento; 1,06-80,2). Conclusiones: En pacientes con infección por el VIH con PPD positivo o anérgicos, la pauta de rifampicina es al menos igual de eficaz para prevenir el desarrollo de tuberculosis que la pauta de isoniacida, y presenta menos efectos adversos (AU)
