Reparación toracoscópica de la atresia esofágica: implicaciones en el pronóstico del paciente / Thoracoscopic Repair of Esophageal Atresia: Implications in the prognosis of the patient

La reparación por toracoscopia de la atresia del esófago se ha constituido paulatinamente en la mejor alternativa terapéutica de los pacientes con esta entidad. Se analizaron 21 pacientes con diagnóstico de atresia esofágica operados por toracoscopia de Noviembre del 2017 a Agosto del 2020. La edad en que se efectuó la cirugía fue de 1 a 15 días de vida, promedio de 4.5. El procedimiento efectuado fue: sección y ligadura de la fistula con anastomosis termino terminal. El tiempo de cirugía fue de 90 a 240 minutos con una media de 158.5 minutos. Las complicaciones postoperatorias fueron: 02 pacientes dehiscencia parcial de la anastomosis, 05 pacientes estrechez de la anastomosis y 01 paciente divertículo traqueal. Hubo 03 pacientes que fallecieron. La reparación toracoscópica de la atresia de esófago es una opción terapéutica eficiente, con una tasa de complicaciones aceptable y una menor mortalidad. (AU)

Thoracoscopic repair of esophageal atresia has gradually become the best therapeutic alternative for patients with this entity. 21 patients with a diagnosis of esophageal atresia operated by thoracoscopy from November 2017 to August 2020 were analyzed. The age at which the surgery was performed was 1 to 15 days old, average 4.5. The procedure was: section and ligation of the fistula with end-to-end anastomosis. The surgery time was 90 to 240 minutes with a mean of 158.5 minutes. Postoperative complications were: 02 patients partial dehiscence of the anastomosis, 05 patients narrowing the anastomosis and 01 patient tracheal diverticulum. There were 03 patients who died. Thoracoscopic repair of esophageal atresia is an efficient therapeutic option, with an acceptable complication rate and lower mortality. (AU)

Retroactive Application of a New Risk Index for Living Donor Kidney Transplantation to Renal Transplants in Veracruz, Mexico.

BACKGROUND: The Living Kidney Donor Profile Index (LKDPI) was recently created. This model predicts recipient risk of graft loss after living donor transplant. Herein, we applied the LDKPI to our population to analyze its performance. METHODS: A retrospective analysis of all living donor kidney transplants from 2003 to 2018 from 2 transplant centers in Veracruz, Mexico, was used. LKDPI was calculated in a webpage (www.transplantmodels.com). Donor and recipient demographics and transplant data included in the model were registered. Pearson correlation between the LKDPI percentage and death-censored graft survival was performed. Kaplan-Meier survival (log-rank) and Cox regression analysis were compared between the LKPDI quartiles. P < .05 was considered statistically significant. RESULTS: In total, 821 transplants were included (mean age 31.7 ± 10.5 years, 62.5% male, n = 513). Mean follow-up was 64.7 ± 46.2 months. Mean estimated survival (Kaplan-Meier) was 128.9 ± 3 months (95% confidence interval [CI], 123-134). Ten-year death-censored graft survival was 61.4%. Median LKPDI was -2%, and mean LKDPI was -2.6% ± 14.6% (range, -50% to 42%). Pearson coefficient correlation between the LKDPI and death-censored graft survival was 0.024 (P = .4). Area under the curve (receiver operating characteristic [ROC]) for the LKDPI and death-censored graft loss was 0.54 (95% CI, 0.505-0.591) (P = .04). Recipients with the lowest LKDPI had lower risk of death-censored graft loss than other quartiles (P = .014 log-rank). Cox regression analysis was significant for the lower LKDPI quartile (<20%) (Exp B = 0.35; 95% CI, 0.14-0.9; P = .03). CONCLUSION: The LKDPI applies with moderate discrimination predictive power in our population. The best LKDPI patient has better death-censored graft survival. Further studies might continue to validate the LKDPI in other cohorts.

Effect of Panel-Reactive Antibody on Graft Survival in Living Kidney Donor Transplantation: Analysis of 10 Years in a Transplant Center in Veracruz, Mexico.

BACKGROUND: Pretransplant anti-HLA antibodies are a risk factor for graft rejection and loss, and its percentage estimate is known as panel-reactive antibody (PRA). Our objective was to evaluate the influence of PRA on the survival of renal grafts from living donors over a period of 10 years. METHODS: Retrospective analysis was completed in all living donor transplants with PRA class I and class II from October 2008 to December 2018 with follow-up until June 2019. The methods used for the PRA were flow cytometry and Luminex. Graft survival (not censored) was evaluated by Kaplan-Meier (log-rank) and Cox regression. P < .05 was considered significant. RESULTS: The study included 393 patients. PRA class I mean was 9.8 ± 20% (0%-98%) and class II mean was 8.6 ± 17.8% (0%-97.8%). Of the patients, 81.9% had a PRA <20% for any class. Uncensored graft survival at 1, 5, and 10 years was 90.3%, 76.2%, and 69.3%, respectively. Mean estimated uncensored graft survival in PRA <20% patients (103.9 ± 2.7, 95% confidence interval [CI] 96.6-11.2) was higher than that of PRA >20% patients (61.5 ± 5.7, 95% CI 50.3-72.8) (P = .005 log-rank). Cox regression (univariate) was statistically significant for PRA class I (Exp [B] 1.01, 95% CI 1.003-1.02, P = .009) and for PRA >20% any class (Exp [B] 2.074, 95% CI 1.222-3.520, P = .007). CONCLUSION: PRA class I and PRA >20% any class are associated with lower graft survival. PRA must be considered to determine immunologic risk and to choose an immunosuppressive regimen in kidney transplantation.

Implementation of a colour-coded universal protocol safety initiative in Guatemala.

BACKGROUND: Universal protocol implementation can be challenging in low-income or middle-income countries, particularly when providers work together across language barriers. The aim of this quality improvement initiative was to test the implementation of a colour-coded universal protocol in a Guatemalan hospital staffed by US and Guatemalan providers. METHODS: From 2013 to 2016, a US and Guatemalan team implemented a universal protocol at a Guatemalan surgical centre for children undergoing general surgical or urologic procedures. The protocol was a two-step patient identification and documentation checklist, with the first step of all chart element verification in the preoperative area, after which a blue hat was placed on the patient as a visual cue that this was completed. The second step included checklist confirmation in the operating room prior to the procedure. We tested protocol implementation over three phases, identifying implementation barriers and modifying clinical workflow after each phase. We measured the error rate in documentation or other universal protocol steps at each phase and made modifications based on iterative analysis. RESULTS: Over the course of programme implementation, we substantially decreased the rate of errors in documentation or other universal protocol elements. After the first phase, 30/51 patients (58.8%) had at least one error. By the third phase, only 2/43 patients (4.6%) had any errors. All errors were corrected prior to surgery with no adverse outcomes. CONCLUSIONS: Care teams of providers from different countries pose potential challenges with patient safety. Implementation of a colour-coded universal protocol in this setting can prevent and reduce errors that could potentially lead to patient harm.

Microencapsulación de aceite de sacha inchi (Plukenetia volubilis L.) mediante secado por aspersión / Microencapsulation of oil sacha inchi (Plukenetia volubilis L.) by spray drying

El objetivo de esta investigación fue microencapsular aceite de sacha inchi mediante secado por aspersión, con el fin de evitar las reacciones oxidativas de degradación, dado su alto contenido de ácidos grasos monoinsaturados y poliinsaturados, los cuales presentan grandes beneficios para la salud. Empleando maltodextrina y goma arábiga en una proporción ( 1:1 ), se evaluó la temperatura de entrada y la carga de aceite, siendo 150 °C y 33% las mejores condiciones de trabajo durante el proceso de secado. Se obtuvo un rendimiento y eficiencia de microencapsulación de 82,10 ± 0,99% y 93,90 ± 0,56%, respectivamente. Cabe mencionar que esta investigación es la primera en emplear la técnica de secado por aspersión, y como agentes formadores de la pared polimérica la mezcla de maltodextrina y goma arábiga en la microencapsulación de aceite de sacha inchi. Mediante análisis fisicoquímico, se evaluó la humedad del aceite de sacha inchi microencapsulado, manteniendo un contenido de humedad a las 26 semanas de 4,60 ± 0,02%. Al utilizar cromatografía de gases se encontró que no existe variación en cuanto al perfil de ácidos grasos antes y después de la microencapsulación, y mediante espectroscopía infrarroja se demostró que el aceite de sacha inchi se encuentra en el interior de las microcápsulas. La microscopía electrónica de barrido permitió observar que las microcápsulas presentan forma esférica con una superficie lisa y libre de poros, lo que evita la exposición directa del aceite a las diferentes condiciones ambientales.

The objective of this research was microencapsulated sacha inchi oil by spray drying, in order to prevent oxidative degradation reactions, given its high content of mono-unsaturated and polyunsaturated fatty acids, which present great health benefits. Employing a maltodextrin-gum arabic system in the same ratio (1:1), the inlet temperature and the oil charge was evaluated, being 150 °C and 33% the best conditions during the drying process, obtaining a performance and efficiency microencapsulation of 82.10 ± 0.99% and 93.90 ± 0.56%, respectively. It should be mentioned that this research is the first one to use the spray drying technique and maltodextrin and arabic gum as polymeric wall formers agents for the sacha inchi oil microen-capsulation. By physicochemical analysis, the microencapsulated sacha inchi oil moisture was evaluated, keeping a moisture content at 26 weeks of 4.60 ± 0.02%, applying gas chromatography, it was found that there is no variation in the fatty acid profile before and after microencapsulation. Through infrared spectroscopy it was shown that sacha inchi oil is inserted into the core of the microcapsules. The electron microscopy scanning allowed to observe that the microcapsules have a spherical shape with a smooth surface and free of pores which prevent direct contact of the oil with different ambient conditions.

Comparación del método de Khun contra la sulfadiacina de plata en el tratamiento tópico de la quemaduras en niños / Comparison betwen khun's method vrs. silver sulfadiazine in the topical treatment of burns in children

Introducción: En el transcurso de la historia se han empleado diversas sustancias para el tratamiento tópico en las quemaduras, sin embargo a la fecha no existe aún la terapéutica ideal para la aplicación en estas lesiones.Material y métodos: Realizamos un análisis ambispectivo, en la unidad de quemados de cirugía pediátrica del Hospital General San Juan de Dios y comparamos los resultados del tratamiento tópico con sulfadiacina de plata contra el método Khun.Resultados: Se revisaron 341 expedientes de pacientes con quemaduras de segundo y tercer grado, 179 fueron tratados con sulfadiacina de plata y 162 con el método de Khun. La estancia hospitalaria osciló entre 2 y 148 días, los pacientes tratados con sulfadiacina de plata tuvieron una media de 19.4 días y los tratados con el método Khun 12.4 días. El número de curaciones diarias durante los primeros 7 días efectuadas a los pacientes que recibieron tratamiento con sulfadiacina de plata fue de 2, mientras que los tratados con el método Khun no las requerían. La morbilidad fue de 57 pacientes, de los que 41 recibieron tratamiento con sulfadiacina de plata y 16 con el método de Khun. La mortalidad fue de 18 pacientes, 7 tratados con el método de Khun y 11 con sulfadiacina de plata.Conclusiones: En conclusión en nuestra unidad el método de Khun fue superior a la sulfadiacina de plata como tratamiento tópico en pacientes quemados.

Cambios en los niveles estriatales de glutamato y aspartato en un modelo de la corea de Huntington: prevención de la neurotoxicidad del ácido quinolínico por kinurenina y probenecid / Changes in the striatal levels of glutamate and aspartante in a Huntington chorea model: prevention of quinolinic acid induced neurotoxicity by kynurenine and probenecid

La kinurenina (KYN) es el metabolito precursor del antagonista de los receptores glutamatérgicos para N-metil-D-as-partato (NMDA), el ácido kinurénico (KYNA). Por su pate, el probenecid (PROB) bloquea la excreción del KYNA desde el fluido extracelular. El KYNA antagoniza la neurotoxicidad ácido quinolínico (QUIN), en el cerebro de mamíferos. En este trabajo evaluamos el efecto de la administración sistémica de KYN y del PROB por separado o en combinación, sobre el contenido estriatal de dos aminoácidos excitadores del sistema nervioso, los ácidos glutámico (Glu) y aspártico (Asp), después de la administración intraestriatal unilateral de QUIN (240 nmol/ml) a las ratas. Los contenidos estriales de Glu y Asp. Analizados por cromatografía de líquidos, se encontraron disminuidos en ratas lesionadas por QUIN al compararse contra valores control (-44 por ciento y -43 por ciento, respectivamente). Los cambios en las concentraciones de estos aminoácidos fueron parcial o totalmente prevenidos por la administración de los pretratamientos con KYN (150, 300 ó 450 mg/kg, i.p.) o PROB (100, 200 ó 300 mg/kg, i.p.) a las ratas 2 horas antes de la inyección del QUIN. La coadministración de ambos fármacos previno la pérdida estriatal de Glu y Asp mediada por QUIN. Por su parte, la administración de un conocido antagonista de los receptores para NMDA, la dizocilpina (MK-80 1, 10 mg/kg, i.p.) previno totalmente la disminución estriatal de ambos aminoácidos. Estos hallazgos sugieren un papel farmacológico de la KYN y del PROB como inductores del antagonismo del KYNA sobre los receptores para NMDA