Determining factors on length of stay in primary total knee arthroplasty patients using enhanced recovery protocol after surgery (ERAS) pathway. / Factores determinantes de la duración de la estancia hospitalaria en pacientes operados de artroplastia primaria total de rodilla usando un protocolo de recuperación mejorada (ERAS).

INTRODUCTION: There is an increase in degenerative arthropathies because of the increase in the longevity of world's population, making primary knee arthroplasties a procedure to recover quality of life without pain. There are factors associated with the length of hospital stay after this procedure. OBJECTIVE: To determine the risk factors influencing the hospital stay during the postoperative period of patients undergoing primary total knee arthroplasty with an enhanced recovery after surgery protocol (ERAS). METHODS: A retrospective study is carried out on patients undergoing primary total knee arthroplasty at a University Hospital in the period 2017-2020 using the ERAS protocol, during which 957 surgeries were performed. RESULTS: Average age of 71.7 ± 8.2 years, 62.4% were women and the 77.3% were classified as ASA II. The significantly associated factors to an increased length of stay are: age (P = .001), ASA scale (P = .04), day of surgery (P < .001), blood transfusion (P < .001), postoperative haemoglobin level at 48-72 h (P < .001), the time of first postoperative mobilization to ambulate and climb stairs (P < .001), the need for analgesic rescues (P = .003), and the presence of postoperative nausea and vomiting (P = .008). CONCLUSIONS: There are statistically significant and clinically relevant factors associated with hospital stay. Determining these factors constitutes an advantage in hospital management, in the development of strategies to improve and optimize the quality of care and available health resources.

(Preoperative instillation of epinephrine and lidocaine may reduce the surgical time of endoscopic treatment of GTPS.). / La instilación preoperatoria de epinefrina y lidocaína puede reducir el tiempo quirúrgico del tratamiento endoscópico de SDTM.

INTRODUCTION: Greater Trochanteric Pain Syndrome (GTPS) is a multifactorial clinical condition affecting the lateral area of the hip. Although conservative treatment shows good results, some patients may still require surgical bursectomy, which can be performed either openly or endoscopically. One of the main technical difficulties of the endoscopic procedure is intraoperative bleeding, which can hinder the medical team's vision and increase the operation time for endoscopic treatment of GTPS. HYPOTHESIS: An instillation of vasoconstrictors and local anesthetics before endoscopy will cause less intraoperative bleeding, which will translate into shorter surgical time. MATERIALS AND METHODS: A prospective cohort was retrospectively divided based on the use or absence of a preoperative instillation of physiological saline solution with epinephrine and lidocaine. Surgical time was measured in each procedure and compared between the two groups. RESULTS: 139 hips from 139 patients were included in the analysis. 102 patients were included in the instillation group versus 37 in the control group. The surgical time was significantly shorter in the instillation group than in the control group, with an average (standard deviation) of 52.01 (14.71) and 72.30 (11.70) minutes, respectively (p < 0.001). CONCLUSION: The instillation of a physiological saline solution with epinephrine and lidocaine prior to the surgical treatment of GTPS is effective in reducing surgical times, likely due to a reduction in intraoperative bleeding. Future research should focus on more direct outcomes such as intraoperative blood loss and between different instillation protocols.

Utilización de los medios de comunicación y actitudes frente a las pantallas en niños de 36-72 meses: estudio descriptivo transversal / Media use and attitudes towards screens in children aged 36-72 months; a cross-sectional, descriptive study

Introducción. La edad en que los niños son introducidos a los dispositivos de comunicación es cada vez más temprana. Las investigaciones sobre los hábitos relacionados con ellos, en niños pequeños, son importantes. El objetivo de este estudio fue describir los hábitos sobre el uso de dispositivos mediáticos (edad de comienzo, tiempo frente a las pantallas, preferencias populares) de niños preescolares y explorar la relación con las características familiares. Población y métodos. Estudio descriptivo transversal: Los padres de niños de 36-72 meses que asistían a los centros de cuidado infantil en Kayseri, una ciudad central de Anatolia, Turquía, completaron un cuestionario sobre los hábitos familiares y de los niños, relacionados con los medios de comunicación. Resultados. Se incluyeron 858 cuestionarios. El 28 % de los niños utilizaban pantallas por más de 2 h/día; el 36 % fueron introducidos a los dispositivos de comunicación antes de los 2 años de edad. La televisión fue el dispositivo más usado (95 %), y los dibujos animados, el programa elegido en el 86,7 %. Los hijos de padres con educación superior tuvieron menos tiempo de pantallas frente a la televisión, la computadora o el teléfono móvil (p = 0,012; p = 0,007; p <0,01 para la madre y p = 0,049; p = 0,032; p = 0,04 para el padre respectivamente). La introducción de libros en los primeros 6 meses de edad se asoció con menor tiempo diario frente a las pantallas (p = 0,011; p = 0,009; p = 0,002 para televisión, computadora y teléfono móvil, respectivamente). El tiempo de los padres frente a la televisión se correlacionó positivamente con el de los niños (p <0,05; r: 0,354). Conclusión. El nivel de educación de los padres, el tiempo que ellos dedican a las pantallas y la introducción de libros en etapas tempranas se relacionaron con los hábitos de los niños frente a los dispositivos mediáticos. Se necesitan estudios amplios para explicar esta relación con mayor claridad.

Introduction: The age at which children are introduced to media devices is becoming increasingly earlier. Studies regarding the media habits of young children have gained importance. The aim of the study was to describe the screen media habits (age of introduction media, time spend with screen, popular choices) of preschool children and to explore their relationship with household characteristics. Population and methods: Cross-sectional descriptive study; the parents of children aged 36-72 months who attended childcare centers in Kayseri, a central Anatolian city in Türkiye, completed a questionnaire on media habits of families and children. Results: There were 858 questionaires included. The proportion of children using screen media more than 2 h/day was 28%; 36% of children were introduced to media devices before the age of two. The most frequently used media tool was television (95%) and the program watched was cartoons for TV (86.7%). Children of highly educated parents had shorter TV, computer and smartphone screen time (p = 0.012, p = 0.007, p <0.01 for mother and p = 0.049, p = 0.032, p = 0.04 for father respectively). Introducing books in the first 6 months was associated with shorter daily screen time (p = 0.011, p = 0.009, p = 0.002 for TV, computer and smartphone ,respectively). Parent's time spent on TV was positively correlated with children's time spent on TV (p <0.05, r = 0.354). Conclusion: Parents' education levels, parents' screen time and introducing book in early age was related to children's media habits. Comprehensive studies are needed to explain this relationship more clearly.

Repetition of thyroid fine-needle aspiration cytology after an initial nondiagnostic result: Is there an optimal timing?

INTRODUCTION: It is suggested to wait at least 3 months to repeat a fine needle aspiration cytology (FNAC) to avoid possible inflammatory cytological changes induced by a previous procedure. This study evaluated the influence of the interval between 2 FNACs in a cohort with a previous non-diagnostic (ND) FNAC. We analysed the occurrence of ND or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) results in the second FNAC, based on the intervals between procedures. PATIENTS AND METHODS: Retrospective study (2017-2020) including thyroid nodules with a ND result, subjected to another FNAC. Demographic, clinical and echographic data, interval between FNACs and their results were collected. We considered the intervals: ≤/>3 months and ≤/>6 months. Second FNAC results were classified as ND, AUS/FLUS or diagnostic (including the other Bethesda categories). RESULTS: Included 190 nodules (190 patients - 82.1% women, mean age 60±13.7 years) with a first ND FNAC. The second FNAC results were: ND in 63 cases, AUS/FLUS in 9 and diagnostic in 118 cases. There were no statistical differences in FNAC results performed≤3 months (13 ND, 2 AUS/FLUS, 19 diagnostic) vs >3 months (50 ND, 7 AUS/FLUS, 99 diagnostic; p=0.71). Similarly, there were no statistical differences considering a longer time interval: ≤6 months (32 ND, 3 AUS/FLUS, 59 diagnostic) vs >6 months (31 ND, 6 AUS/FLUS, 59 diagnostic; p=0.61). CONCLUSIONS: Time interval between FNACs was not relevant to the final cytological result. Early FNAC repetition did not increase the cases of ND or AUS/FLUS.

Superiority of 3D planimetry over pressure half-time method for the assessment of mitral valve area after percutaneous edge-to-edge mitral repair.

INTRODUCTION AND OBJECTIVES: There is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient. METHODS: A registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient. RESULTS: We analyzed data from 167 patients. The mean age was 76±10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89±0.60 cm2 using pressure half-time (PHT), 2.87±0.83 cm2 using 3D planimetry, and the mean gradient was 3±1.19mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (r=0.46, P<.001) than MVA obtained by PHT (r=0.19, P=.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively). CONCLUSIONS: Our study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.

Safe administration of noradrenaline by the peripheral route: A systematic review. / Administración segura de noradrenalina por vía periférica: una revisión sistemática.

PURPOSE: To review and analyze the available literature on peripheral administration of noradrenaline (NA) with the aim of providing recommendations to ensure correct use and patient safety. METHODS: Systematic review on the databases PubMed, ISI Web of Science, SCOPUS and Science Direct, using the following search terms: ("Noradrenaline" [Mesh]) AND ("Norepinephrine" [Mesh]) AND ("Vasopressors" [Mesh]) AND ("Peripheral infusions" [Mesh]) OR ("Extravasations" [Mesh]). A total of 1,040 articles were identified. Animal studies and studies written in languages other than English were excluded. Finally, 83 articles were included. RESULTS: NA can be administered peripherally. The risk of extravasation should be taken into account, with phentolamine being the first pharmacological line of treatment. It has also been related to the appearance of thrombophlebitis, cellulitis, tissue necrosis, limb ischemia and gangrene, although its incidence seems to be low. The use of peripheral NA in children seems to be carried out without obvious complications. The use of standard concentrations is suggested to reduce the risk of errors. It is recommended to use 0.9% saline as the default diluent for peripheral NA. CONCLUSIONS: Peripheral infusions of NA could be a safe and beneficial option in early resuscitation provided that a number of guidelines are followed that reduce the likelihood of complications associated with this route.

Comparison of early and late removal of the urinary catheter after rectal cancer surgery.

OBJECTIVE: This study is aiming to compare the results of early and late removal of urinary catheters after rectal cancer surgery. MATERIALS AND METHODS: Patients who undergone rectal cancer surgery in a single center were included in this prospective randomized study. The timing of the urinary catheter removal was randomized by a computer-assisted program and divided into 2 groups, which are early (first 48 h) and late (after 48 h). The primary outcome of this study was to compare the urinary retention and re-catheterization rates between patients with early and those with late catheter removal. RESULTS: Sixty-six patients were included in this study. The median age was 60 (31-88 years), and the patient group was predominantly male (n: 40, 60.9%). Urinary retention after catheter removal developed in 8 (12%) of 66 patients. There was no difference between the two groups in terms of the need for re-catheterization (14% vs. 10%, p: 0.63). All the patients who required re-catheterization (n: 8) and were discharged with a urinary catheter (n: 4) were male. When the male and female patients were evaluated separately, there was no difference in urinary retention in the early or late groups. CONCLUSIONS: Early or late removal of the catheter does not play a role in the development of urinary retention in patients undergoing rectal cancer surgery.

OBJETIVO: Comparar los resultados de la retirada precoz y tardía de la sonda urinaria tras la cirugía de cáncer rectal. MÉTODO: Estudio prospectivo aleatorizado que incluyó pacientes sometidos a cirugía de cáncer rectal en un único centro. El momento de la retirada de la sonda urinaria se aleatorizó y se dividió en dos grupos: primeras 48 horas y después de 48 horas. Se compararon las tasas de retención urinaria y de nueva cateterización entre los pacientes con retirada precoz y tardía de la sonda. RESULTADOS: Se incluyeron 66 pacientes, con una mediana de edad de 60 años (31-88 años) y predominio del sexo masculino (n = 40, 60.9%). Se produjo retención urinaria tras la retirada de la sonda en 8 (12%). No hubo diferencias entre los dos grupos en cuanto a necesidad de nueva cateterización (14% frente a 10%, p = 0.63). Todos los pacientes que precisaron un nuevo cateterismo (n = 8) y fueron dados de alta con una sonda urinaria (n = 4) eran varones. CONCLUSIONES: La retirada precoz o tardía de la sonda no influye en la aparición de retención urinaria en pacientes intervenidos de cáncer de recto.

Effect of coadministration of 10 mg/kg calcium chloride and neostigmine on extubation time: A randomized controlled trial.

INTRODUCTION AND OBJECTIVES: Some studies investigating the effect of calcium on neostigmine-induced recovery of neuromuscular blockade have shown that this combination promotes neuromuscular recovery, but does not significantly affect the incidence of postoperative residual curarization and time to extubation. This study aimed to evaluate the effects of 10 mg/kg calcium chloride co-administered with neostigmine on early recovery and time to extubation. PATIENTS AND METHODS: This prospective, randomized, double-blinded, placebo-controlled study included 88 ASA I-II patients aged between 18 and 65 years who were scheduled for elective surgery lasting at least 1 h under general anaesthesia in which 10 mg/kg of calcium chloride or the same volume of normal saline was co-administered with 5 µg/kg of neostigmine at the end of surgery. Time to extubation (time from neostigmine administration to extubation), time from neostigmine administration to TOF ratio (TOFr) 0.9 (neuromuscular recovery), and the incidence of residual neuromuscular blockade (RNMB) and other adverse effects were recorded. RESULTS: Median (Q1, Q3) extubation time was significantly shorter in the calcium group vs. the placebo group (6.5 min [5.52-7.43] vs. 9.78 min [8.35-11]), P < .001. Median neuromuscular recovery time in the calcium group was 5 min vs. 7.1 min in the placebo group, P < .001. Patients in the calcium group had significantly higher TOFr and lower incidence of RNMB at 5 and 10 min vs. the placebo group, and no significant side effects. CONCLUSION: Calcium chloride at a dose of 10 mg/kg co-administered with neostigmine promotes early neuromuscular recovery and reduces time to extubation by about 32%.

Sex differences in delay times in ST-segment elevation myocardial infarction: A cohort study.

BACKGROUND: The present study analyzes a cohort of consecutive patients with ST-segment elevation acute myocardial infarction (STEMI), evaluating the ischemia-reperfusion times from the perspective of gender differences (females versus males), with a long-term follow-up. METHODS: Single-center analytical cohort study of patients with STEMI in a tertiary hospital, between January 2015 and December 2020. RESULTS: A total of 2668 patients were included, 2002 (75%) men and 666 (25%) women. The time elapsed from the onset of symptoms to the opening of the artery was 197min (IQR 140-300) vs 220min (IQR 152-340), p=0.004 in men and women respectively. A delay in health care significantly impacts the occurrence of cardiovascular adverse events at follow-up, HR 1.34 [95%CI 1.06-1.70]; p=0.015. CONCLUSIONS: Women took longer to go to health care services and had a longer delay both in the diagnosis of STEMI and in coronary reperfusion. It is imperative to emphasize the necessity of educating women about the recognition of ischemic heart disease symptoms, empowering them to raise early alarms and seek timely medical attention.

Lifestyles of 2- to 11-year-old children during the CoViD-19 pandemic / Estilos de vida de niños de 2 a 11 años durante la pandemia de COVID-19

Introduction: risk factors associated with obesity such as poor dietary quality, low physical activity (PA), screen time (ST), and poor sleep duration (SD) were affected during confinement resulting from the SARS-CoV-2 pandemic. Objective: the aim of our study was to evaluate the association between PA, ST and SD with the consumption of non-recommended food groups (N-RFG) in children during the COVID-19 pandemic, using data from ENSARS-CoV-2 Girls and Boys. Methods: data were gathered through a self-administered electronic survey carried out in four regions of Mexico during September and October 2020. Dietary patterns were established using k-means cluster analysis. Linear regression models were used to study the effect of food consumption patterns and PA on hours of ST per week. Results: in all, 2,405 children aged 2 to 11 were studied. Three food group consumption patterns were identified. Group 1 or “high consumption of added sugars group” and Group 2 or “high consumption of N-RFG group” children reported more hours of ST than those in Group 3 or “low consumption of N-RFG group” (p < 0.001 and p < 0.001, respectively). Group 2 reported more hours per week of ST but also more days of PA vs Group 3. Conclusion: confronted by the pandemic, it is essential to redouble efforts to reverse the harmful effects of lifestyles during the COVID-19 pandemic to improve the health of Mexican children in the years to come.(AU)

Introducción: los factores de riesgo asociados a la obesidad, como la pobre calidad de la dieta, la baja actividad física (AF), el tiempo frente a pantallas (TP) y la corta duración del sueño (DS), se vieron afectados durante el confinamiento resultado de la pandemia por SARS-CoV-2. Objetivo: el objetivo del estudio fue evaluar la asociación entre AF, TP y DS y el consumo de grupos de alimentos no recomendados (GANR) en niños durante la pandemia por COVID-19, utilizando datos de la ENSARS-CoV-2 Niñas y Niños.Métodos: la información fue recolectada por medio de una encuesta electrónica autoadministrada durante septiembre y octubre de 2020 en las 4 regiones de México. Para establecer patrones de consumo de alimentos se utilizó un análisis de conglomerados por el método de las medias k. Se utilizaron modelos de regresión lineal para estudiar los efectos de los patrones de consumo de alimentos sobre AF y TP. Resultados: la muestra fue de 2,405 niños de 2 a 11 años de edad. Se identifi caron 3 grupos de patrones de consumo de alimentos. El grupo 1 o de “alto consumo de azúcares añadidos” y el grupo 2 o de “alto consumo de GANR” reportaron un mayor número de horas a la semana frente a una pantalla en comparación con el grupo 3 o de “bajo consumo de GANR” (p < 0,001 y p < 0,001, respectivamente). El grupo 2 reportó menos horas a la semana de TP pero también más días de AF con respecto al grupo 3.Conclusión: se ha vuelto esencial duplicar los esfuerzos para revertir los efectos nocivos en los estilos de vida que se establecieron durante la pandemia para mejorar la salud de los niños mexicanos en los años subsecuentes.(AU)

Future Anxiety in Young Spanish Adults: Psychometric Properties of the Dark Future Scale / Ansiedad Futura en Adultos Jóvenes Españoles: Propiedades Psicométricas de la Dark Future Scale

Background/Objective: The Dark Future Scale (DFS) is a self-report instrument which assesses the tendency to think about the future with anxiety, fear, and uncertainty. Although it has been applied in different populations, instrumental studies are scarce, and there is no validated Spanish version. The aim was therefore to develop a Spanish version of the scale (DFS-S) and to analyze its psychometric properties in a sample of young adults. Method: Participants were 1,019 individuals aged from 18 to 24 years. They completed the DFS-S and the IPIP-BFM-20. Validity evidence based on the internal structure, including measurement invariance across gender, as well as on relationships with personality traits was obtained. Reliability and gender differences in DFS-S scores were also examined. Results: Results supported a single-factor structure, χ2(5) = 10.79, CFI = .999, RMSEA = .034, SRMR = .016, that was invariant across gender. Reliability of test scores was satisfactory (ω = .92). In the correlation analysis, future anxiety showed a strong positive correlation with neuroticism (.42) and a moderate negative correlation with extraversion (-.25). Females scored higher than males on future anxiety. Conclusions: The DFS-S has satisfactory psychometric properties and it is an adequate tool for measuring future anxiety among young adults.(AU)

Antecedentes/Objetivo: La Dark Future Scale (DFS) evalúa la ten-dencia a pensar en el futuro con ansiedad, miedo e incertidumbre. Aunque ha sido usadaen diferentes poblaciones, los estudios instrumentales son es-casos y no hay una versión adaptada al español. El objetivo del estudio fue adaptarla al español (DFS-S) y analizar sus propiedades psicométricas en una muestra de adultos jóvenes. Método:Participaron 1.019 jóvenes entre 18 y 24 años. Completaron la DFS-S y el IPIP-BFM-20. Se analizan evidencias de validez basadas en la estructura interna, incluyendo la invarianza de me-dida según el género, y basadas en las relaciones con rasgos de personali-dad, así como análisis de la fiabilidad y de las diferencias de género. Resulta-dos:Los resultados apoyaron una estructura de un solo factor, χ2(5) = 10.79, CFI = .999, RMSEA = .034, SRMR = .016, con invarianza respecto al gé-nero, y con coeficiente de fiabilidad satisfactorio (ω= .92). Se encontró co-rrelación positiva fuerte entre ansiedad futura y neuroticismo (.42) y una correlación negativa moderada con extraversión (-.25). Las puntuaciones en ansiedad futura fueron mayores en las mujeres. Conclusiones:Los resultados muestran propiedades psicométricas satisfactorias delaDFS-S, siendo un instrumento adecuado para medir la ansiedad futura en adultos jóvenes.(AU)

Does the righting behaviour effectively reflect stress in Arbacia dufresnii Arbacioida: Arbaciidae)? / ¿El comportamiento de enderezamiento refleja efectivamente el estrés en Arbacia dufresnii (Arbacioida: Arbaciidae)?

Resumen Introducción: El comportamiento de enderezamiento se ha utilizado como indicador de salud en respuesta a variables estresantes. La aplicación de este parámetro en acuicultura podría ser beneficiosa para reducir la mortalidad y mejorar el bienestar en el cultivo del erizo de mar Arbacia dufresnii. Objetivo: El objetivo de este estudio fue evaluar el efecto del sexo, el diámetro y tres factores estresantes sobre el comportamiento de enderezamiento del erizo de mar A. dufresnii. Métodos: Se midieron un total de 300 animales para evaluar el tiempo de comportamiento de enderezamiento completo (CRB) y 100 de ellos también registraron el tiempo de comportamiento de enderezamiento medio (HRB). Se aplicaron tres factores estresantes a los animales: repeticiones seriadas (tres giros sucesivos), temperatura (shock de 24 horas) e inducción del desove con inyección de KCl. El tiempo se midió con un cronómetro y el diámetro con un calibre de precisión. Resultados: El tiempo de enderezamiento resultó ser dependiente del diámetro, pero independiente del sexo. El límite superior de temperatura de 19 °C tuvo un efecto significativo en el comportamiento de enderezamiento en comparación con las temperaturas de 16 °C y 13 °C, con tiempos de CRB de hasta 150 segundos. Las repeticiones seriadas y el desove no tuvieron un efecto significativo. Sin embargo, con base en los tiempos registrados, se puede deducir que el desove tuvo un impacto en la salud de los animales con tiempos de CRB de hasta 150 segundos en comparación con el control, con tiempos inferiores. Conclusiones: El comportamiento de enderezamiento completo (CRB) parece ser un indicador óptimo para evaluar la salud y condición del erizo de mar A. dufresnii, sin embargo sería óptimo realizar más ensayos para corroborar el efecto del tratamiento control con respecto al desove.

Approach to the care process by nurse case managers in a breast unit.

OBJECTIVE: Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. METHODS: Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed RESULTS: A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). CONCLUSIONS: The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.

Protocolo de recuperación mejorada después de cirugía (ERAS) atenúa el estrés y acelera la recuperación en pacientes después de resección radical por cáncer colorrectal: Experiencia en la Clínica Universitaria Colombia / Enhanced Recovery After Surgery (ERAS) protocol attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: Experience at Clínica Universitaria Colombia

Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.

Effect of turbinate surgery on mucociliary clearance. A systematic review and metanalysis / Efecto de la cirugía turbinal en el aclaramiento mucociliar. Revisión sistemática y metaanálisis

Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. ... . (AU)

A pesar de que la cirugía turbinal tiene efectos positivos en la ventilación nasal, gran parte de estos procedimientos son agresivos con el epitelio respiratorio. Existen hipótesis que sugieren que la cirugía turbinal puede mejorar el aclaramiento mucociliar (AMC) al mejorar la rinitis, así como alterarlo al lesional el epitelio nasal. Esta revisión se diseña con el objetivo de explorar el efecto de la cirugía turbinal en el AMC. Se revisó Pubmed (Medline), the Cochrane Library, EMBASE, SciELO. 4 autores miembros de YO-IFOS grupo de estudio en rinología, analizaron de manera independiente los artículos. Las variables analizadas fueron tamaño muestral, edad, indicación quirúrgica, técnica quirúrgica, método de medición de AMC, AMC antes y después de la cirugía y resultado principal. Se incluyeron 15 estudios con 1936 participantes (1618 excluyendo controles sanos). 9 estudios fueron combinados en un metanálisis que demostró una diferencia no estadísticamente significativa de -3,86 minutos en AMC tras cirugía (p = 0,06). El análisis por subgrupos de las 5 cohortes sometidas a turbinoplastia con microdebridador si fueron estadísticamente significativas con una diferencia de -7,02 minutos (p < 0,001). El grupo sometido a laser (4 cohortes) también obtuvo diferencia estadística, aunque menor, -1,01 minutos (p < 0,001). Esta revision y metaanálisis sugiere que la cirugía turbinal no afecta al aclaramiento mucociliar. La evidencia disponible también sugiere que las técnicas menos agresivas con la mucosa mejoran el AMC, mientras que las agresivas podrían aumentarlo o no modificarlo. Este efecto beneficioso se observa desde el 1º al 3º mes postquirúrgico. Sin embargo, para poder obtener adecuadas conclusiones, debe existir un método estandarizado para medir el AMC, así como un método para describir adecuadamente la extensión quirúrgica. (AU)

The CoNUT score predicts the length of hospital stay and the risk of long CoVID / La puntuación CONUT predice la duración de la estancia hospitalaria y el riesgo de COVID persistente

Objective: the Controlling Nutritional Status (CONUT) score is an objective tool widely used to assess nutritional status of patients. We aimed toinvestigate the value of CONUT score on predicting length of hospital stay (LOS) and the risk of long COVID in patients with COVID-19.Methods: a total of 151 patients with COVID-19 were enrolled for analysis. Patients were followed up for two years from three months after theonset of SARS-CoV-2 infection. CONUT score was calculated on admission. The correlation between CONUT score and LOS were assessed bySpearman’s rank correlation coefficient and multivariate linear analysis. The association between different CONUT grade and long COVID wasevaluated by Kaplan-Meier survival curves with log-rank test and Cox proportional hazard models.Results: Spearman’s rank correlation coefficient showed that CONUT scores were positively correlated with LOS (r = 0.469, p < 0.001). Multivari-ate linear analysis showed that CONUT score is the only independent determinant of LOS (B 2.055, 95 % CI: 1.067-3.043, p < 0.001). A total of 53(35.10 %) patients with long COVID were identified. Kaplan-Meier cumulative survival curves and Cox proportional hazards analyses showed thatthe incidence of long COVID in patients with a higher CONUT score was significantly higher than in patients with lower CONUT score (p < 0.001).Conclusions: higher CONUT score predicts longer LOS and the risk of long COVID in patients with COVID-19. The CONUT score might be usefulfor risk stratification in COVID-19 patients and help to develop new nutritional treatment strategies for long COVID.(AU)

Objetivo: la escala de valoración del estado nutricional CONUT es una herramienta objetiva ampliamente utilizada para evaluar el estado nutricionalde los pacientes. Nuestro objetivo fue investigar el valor de la puntuación CONUT para predecir la duración de la estancia hospitalaria (LOS) y elriesgo de COVID persistente en pacientes con COVID-19.Métodos: se inscribieron para el análisis un total de 151 pacientes con COVID-19. Los pacientes se sometieron a un seguimiento de dos añosa partir de los tres meses posteriores al inicio de la infección por SARS-CoV-2. La puntuación CONUT se calculó al ingreso. La correlación entrela puntuación CONUT y la LOS se evaluó mediante el coeficiente de correlación de rangos de Spearman y el análisis lineal multivariante. Laasociación entre diferentes grados CONUT y COVID persistente se evaluó mediante curvas de supervivencia de Kaplan-Meier con prueba derango logarítmico y modelos de riesgo proporcional de Cox.Resultados: el coeficiente de correlación de rango de Spearman mostró que las puntuaciones CONUT se correlacionaron positivamente con LOS(r = 0,469, p <0,001). El análisis lineal multivariante mostró que la puntuación CONUT es el único determinante independiente de LOS (B 2,055,IC 95 %: 1,067-3,043, p < 0,001). Se identificaron un total de 53 (35,10 %) pacientes con COVID persistente. Las curvas de supervivenciaacumulada de Kaplan-Meier y los análisis de riesgos proporcionales de Cox mostraron que la incidencia de COVID persistente en pacientes conuna puntuación CONUT más alta fue significativamente mayor que en pacientes con una puntuación CONUT más baja (p < 0,001).Conclusiones: una puntuación CONUT más alta predice una LOS más larga y el riesgo de COVID persistente en pacientes con COVID-19. Lapuntuación CONUT podría ser útil para la estratificación de riesgo en pacientes con COVID-19 y ayudar a desarrollar nuevas estrategias detratamiento nutricional para COVID persistente.(AU)

Determining factors on length of stay in primary total knee arthroplasty patients using enhanced recovery protocol after surgery (ERAS) pathway. / Factores determinantes de la duración de la estancia hospitalaria en pacientes operados de artroplastia primaria total de rodilla usando un protocolo de recuperación mejorada (ERAS).

INTRODUCTION: There is an increase in degenerative arthropathies because of the increase in the longevity of world's population, making primary knee arthroplasties a procedure to recover quality of life without pain. There are factors associated with the length of hospital stay after this procedure. OBJECTIVE: To determine the risk factors influencing the hospital stay during the postoperative period of patients undergoing primary total knee arthroplasty with an enhanced recovery after surgery protocol (ERAS). METHODS: A retrospective study is carried out on patients undergoing primary total knee arthroplasty at an University Hospital in the period 2017-2020 using the ERAS protocol, during which 957 surgeries were performed. RESULTS: Average age of 71.7±8.2years, 62.4% were women and the 77.3% were classified as ASAII. The significantly associated factors to an increased length of stay are: age (P=.001), ASA scale (P=.04), day of surgery (P<.001), blood transfusion (P<.001), postoperative hemoglobin level at 48-72h (P<.001), the time of first postoperative mobilization to ambulate and climb stairs (P<.001), the need for analgesic rescues (P=.003), and the presence of postoperative nausea and vomiting (P=.008). CONCLUSIONS: There are statistically significant and clinically relevant factors associated with hospital stay. Determining these factors constitutes an advantage in hospital management, in the development of strategies to improve and optimize the quality of care and available health resources.

Detección y cuantificación de VHB y VHC en muestras de plasma mediante la utilización de diferentes ensayos moleculares: estudio comparativo / Detection and quantification of HBV and HCV in plasma samples by means of different molecular assays: Comparative study

Introducción: La carga viral es un marcador muy útil para realizar el seguimiento de los pacientes infectados por VHB y VHC. Este trabajo compara ensayos basados en amplificación mediada por transcripción y en PCR a tiempo real con el objetivo de comprobar si pueden ser intercambiables. Material y métodos: Estudio bicéntrico en el que se analizó la carga viral de 147 muestras de plasma de pacientes infectados por VHB y 229 por VHC, mediante ensayos basados en amplificación mediada por transcripción (Aptima® HBV Quant y Aptima® HCV Quant Dx, que utilizan el sistema Panther (Hologic®)) y PCR a tiempo real (COBAS® AmpliPrep / COBAS® TaqMan® y COBAS® 6800), calculando el grado de concordancia entre ellos. Resultados: Se detectó carga viral en ambos equipos en 60 (40,82%) muestras de VHB (mediana del log de la carga viral: COBAS®: 2,51UI/mL (RIC 2,20-3,17), Panther: 2,71UI/mL (RIC 2,21-3,22)) y en 39 (16,96%) muestras de VHC (mediana del log de la carga viral: COBAS®: 3,93UI/mL (RIC 2,24-6,01), Panther: 3,80UI/mL (RIC 1,99-6,14)). La concordancia entre ambos equipos fue de κ=0,943 para VHB y κ=0,925 para VHC. La comparación de las muestras con carga viral detectada mediante los 2 ensayos mostró una correlación alta tanto para VHB (R2=0,86) como para VHC (R2=0,97). Conclusiones: Los ensayos basados tanto en amplificación mediada por transcripción como en PCR a tiempo real pueden ser intercambiables para el manejo de pacientes infectados con VHB y VHC.(AU)

Introduction: Viral load is a very useful marker for monitoring patients infected with HBV and HCV. This work compares assays based on transcription-mediated amplification and on real-time PCR to verify whether they can be interchangeable. Material and methods: a bicentric study, in which 147 plasma samples from patients infected with HBV and 229 with HCV were analyzed, was carried out. Transcription-mediated amplification-based assays (Aptima® HBV Quant and Aptima® HCV Quant Dx, employing Panther system (Hologic®)) and on real-time PCR (COBAS® AmpliPrep / COBAS® TaqMan® and COBAS® 6800) were used and the degree of concordance between them was calculated. Results: Viral load was detected in both systems in 60 (40.82%) HBV samples (median log viral load: COBAS®: 2.51IU/mL (IQR 2.20-3.17), Panther: 2.71IU/mL (IQR 2.21-3.22)) and in 39 (16.96%) HCV samples (median log viral load: COBAS®: 3.93IU/mL (IQR 2.24-6.01), Panther: 3.80IU/mL (IQR 1.99-6.14)). The agreement between both systems was κ=0.943 for HBV and κ=0.925 for HCV. Comparison of viral load samples detected by both assays showed a hight correlation for HBV (R2=0.86) and for HCV (R2=0.97). Conclusions: Both transcription-mediated amplification and on real-time PCR based assays may be interchangeable for the management of patients infected with HBV and HCV.(AU)

Towards the personalization of septic shock resuscitation: the fundamentals of ANDROMEDA-SHOCK-2 trial.

Septic shock is a highly lethal and prevalent disease. Progressive circulatory dysfunction leads to tissue hypoperfusion and hypoxia, eventually evolving to multiorgan dysfunction and death. Prompt resuscitation may revert these pathogenic mechanisms, restoring oxygen delivery and organ function. High heterogeneity exists among the determinants of circulatory dysfunction in septic shock, and current algorithms provide a stepwise and standardized approach to conduct resuscitation. This review provides the pathophysiological and clinical rationale behind ANDROMEDA-SHOCK-2, an ongoing multicenter randomized controlled trial that aims to compare a personalized resuscitation strategy based on clinical phenotyping and peripheral perfusion assessment, versus standard of care, in early septic shock resuscitation.

Detection and quantification of HBV and HCV in plasma samples by means of different molecular assays: Comparative study.

INTRODUCTION: Viral load is a very useful marker for monitoring patients infected with HBV and HCV. This work compares assays based on transcription-mediated amplification (TMA) and on real-time PCR (RT-PCR) to verify whether they can be interchangeable. MATERIAL AND METHODS: A bicentric study, in which 147 plasma samples from patients infected with HBV and 229 with HCV were analyzed, was carried out. TMA-based assays (Aptima® HBV Quant and Aptima® HCV Quant Dx, employing Panther system (Hologic®)) and RT-PCR (COBAS® AmpliPrep/COBAS® TaqMan® and COBAS® 6800) were used and the degree of concordance between them was calculated. RESULTS: Viral load was detected in both systems in 60 (40.82%) HBV samples (median log viral load: COBAS: 2.51IU/mL (IQR 2.20-3.17), Panther: 2.71IU/mL (IQR 2.21-3.22)) and in 39 (16.96%) HCV samples (median log viral load: COBAS: 3.93IU/mL (IQR 2.24-6.01), Panther: 3.80IU/mL (IQR 1.99-6.14)). The agreement between both systems was κ=0.943 for HBV and κ=0.925 for HCV. Comparison of viral load samples detected by both assays showed a hight correlation for HBV (R2=0.86) and for HCV (R2=0.97). CONCLUSIONS: Both TMA and RT-PCR based assays may be interchangeable for the management of patients infected with HBV and HCV.