Validation of a synthetic simulation model of endoscopic rectus sheath plication.

PURPOSE: Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. METHODS: A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. RESULTS: Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. CONCLUSION: Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.

Prognostic factors for recurrence in patients with papillary thyroid carcinoma.

BACKGROUND: The prognostic factors for tumor recurrence and mortality of patients diagnosed with Papillary Thyroid Carcinoma (PTC) with immediate surgery in Colombia has not been reported. OBJECTIVE: To retrospectively evaluate the risk factors for recurrence and survival at 10 years in patients with the diagnosis of PTC treated at Fundación Santa Fe deBogota (FSFB). METHODS: A total of 486 patients with thyroid surgery accompanied by medical follow-up were recruited. Demographic, clinical, and pathological variables were followed-up for a median period of 10 years. RESULTS: The most significant variables for recurrence were tumors with > 4 cm of size (hazard ratio [HR] = 8.1; 95% confidence interval [CI] = 1.7-55) and extrathyroidal spread (HR = 26.7; 95% CI = 3.1-228). CONCLUSION: PTC in our population has low rates of mortality (0.6%) and recurrence (9.6%), with an average time of recurrence of 3 years. Size of the lesion, positive surgical margins, extrathyroidal spread, and high postoperative serum thyroglobulin (Tg) level act as prognostic factors that determine the likelihood of recurrence. Unlike other studies, the influence of age and gender does not act as a prognostic factor.

Molecular and Computational Strategies to Increase the Efficiency of CRISPR-Based Techniques.

The prokaryote-derived Clustered Regularly Interspaced Palindromic Repeats (CRISPR)/Cas mediated gene editing tools have revolutionized our ability to precisely manipulate specific genome sequences in plants and animals. The simplicity, precision, affordability, and robustness of this technology have allowed a myriad of genomes from a diverse group of plant species to be successfully edited. Even though CRISPR/Cas, base editing, and prime editing technologies have been rapidly adopted and implemented in plants, their editing efficiency rate and specificity varies greatly. In this review, we provide a critical overview of the recent advances in CRISPR/Cas9-derived technologies and their implications on enhancing editing efficiency. We highlight the major efforts of engineering Cas9, Cas12a, Cas12b, and Cas12f proteins aiming to improve their efficiencies. We also provide a perspective on the global future of agriculturally based products using DNA-free CRISPR/Cas techniques. The improvement of CRISPR-based technologies efficiency will enable the implementation of genome editing tools in a variety of crop plants, as well as accelerate progress in basic research and molecular breeding.

Infecciones asociadas con dispositivos, perfil microbiológico y resistencia bacteriana en unidades de cuidados intensivos de Casanare, Colombia / Device-Associated Infections, Microbiological Profile and Bacterial Resistance in Intensive Care Units of Casanare ­ Colombi / Infecções associadas a dispositivos, perfil microbiológico e resistência bacteriana em unidades de terapia intensiva em Casanare (Colômbia)

Introducción: Entre las infecciones asociadas con la atención en salud, las relacionadas con dispositivos constituyen la patología más común en los pacientes que ingresan al servicio de cuidados intensivos. Objetivos: Determinar la distribución de las infecciones asociadas con dispositivos, su perfil microbiológico y resistencia bacteriana en las unidades de cuidados intensivos del departamento de Casanare, Colombia entre 2019 y 2020. Materiales y métodos: Estudio observacional retrospectivo de corte transversal. La población de estudio fueron 93 pacientes admitidos entre enero de 2019 y diciembre de 2020 en dos unidades de cuidados intensivos del depar-tamento de Casanare. La información fue suministrada por la Secretaría de Salud Departamental, a través de los reportes de los laboratorios clínicos por medio del programa WHONET 5.6. Resultados: Las infecciones del torrente sanguíneo asociadas con el uso de catéter fueron las más frecuentes, con un 84 % (n: 78); seguidas de las infecciones sintomáticas de las vías urinarias asociadas con catéter, con un 12 % (n: 11), y en menor proporción las neumonías asociadas con ventilador mecánico, en un 4 % (n: 4). Las bacterias gramnegativas presentaron mayor frecuencia (61 %; n: 14) en relación con las grampositivas (39 %; n: 9). Conclusión: Las infecciones más frecuentes en los servicios analizados fueron las del torrente sanguíneo asociadas con el catéter y Pseudomonas aeruginosa fue el microrganismo más prevalente en los tres tipos de infección; mien-tras que el Enterococcus faecium fue resistente a una variedad de antibióticos. Tales resultados, al ser comparados con estudios realizados en varios países, demostraron que la distribución de estas infecciones es variable. Palabras clave: infecciones oportunistas; unidad de cuidados intensivos; dispositivos de acceso vascular; neumonía asociada al ventilador; infecciones relacionadas con catéteres; agentes antibacterianos; resistencia a medicamentos.

Introduction: Among health care associated infections, device associated infections are the most common pathology in patients admitted to the intensive care service. Objectives: To determine the distribution of device-associated infections, their microbiological profile and bacterial resistance, in the intensive care units of the Department of Casanare between 2019 and 2020. Materials and methods: An observational, retrospective, cross-sectional study was carried out. The study population was 93 patients admitted between January 2019 and December 2020 in two Inten-sive Care Units of the Department of Casanare. The information was provided by the Departmental Health Secretariat through the reports of the Clinical Laboratories through the WHONET 5.6 program. Results: Catheter-associated bloodstream infections were the most frequent with 84% (n: 78), fo-llowed by catheter-associated symptomatic urinary tract infections with 12% (n: 11) and associated pneumonia to a lesser extent 4% mechanical ventilator (n: 4). Gram negative bacteria had a higher frequency 61% (n: 14) compared to Gram positive ones 39% (n: 9). Conclusion: The infection associated with devices, the most frequent in the analyzed services were the infections of the blood stream associated with the catheter and P. aeruginosa was the most preva-lent microorganism in the three types of infection. E. faecium presented resistance to a variety of an-tibiotics, results that when compared with studies carried out in several countries worldwide showed that the distribution of these infections is variable.

Introdução: Entre as infecções associadas aos cuidados de saúde, as infecções associadas a dispositi-vos são a patologia mais comum em pacientes internados em terapia intensiva. Objetivo: Determinar a distribuição de infecções associadas a dispositivos, seu perfil microbiológico e resistência bacteriana em unidades de terapia intensiva no departamento de Casanare, Colômbia entre 2019 e 2020. Materiais e métodos: Estudo retrospectivo observacional transversal. A população do estudo foi de 93 pacientes admitidos entre janeiro de 2019 e dezembro de 2020 em duas unidades de terapia in-tensiva no departamento de Casanare. As informações foram fornecidas pela Secretaria de Saúde do Departamento, através de informes de laboratório clínico utilizando o programa WHONET 5.6. Resultado: As infecções da corrente sanguínea associadas a cateteres foram as mais frequentes com 84% (n: 78), seguidas pelas infecções do trato urinário sintomáticas associadas a cateteres com 12% (n: 11), e em menor grau as pneumonias associadas a ventiladores mecânicos com 4% (n: 4). As bac-térias gram-negativas eram mais frequentes (61%; n: 14) do que as gram-positivas (39%; n: 9). Conclusão: As infecções mais frequentes nos serviços analisados foram infecções associadas a cate-teres e Pseudomonas aeruginosa foi o microrganismo mais prevalente nos três tipos de infecção, en-quanto Enterococcus faecium era resistente a uma variedade de antibióticos. Tais resultados, quando comparados com estudos realizados em vários países, demonstraram que a distribuição dessas infe-cções é variável.

Validity of the Pulmonary Embolism Rule-Out Criteria (PERC) for ruling out pulmonary embolism in low-risk patients at high altitudes

Abstract Objectives: to validate the diagnostic yield of the PERC score for ruling out pulmonary embolism in low-risk patients at high altitudes (>2500 meters above sea level [ASL]). Methods: a cross-sectional study with diagnostic test analysis in patients over the age of 18 with suspected pulmonary embolism on admission or during hospitalization, who underwent chest computed tomography angiography between August 2009 and January 2020 in a tertiary care hospital located on the Bogotá savannah. The yield of the PERC score was assessed, calculated with an SaO2<95% and an SaO2<90% in patients with different risk levels according to the Wells, Geneva and Pisa scores for pulmonary embolism. Results: one thousand eighty-seven were included in the final analysis, 42% with PE. Patients classified as low-risk using the Wells score had a PERC ACOR calculated with SaO2<95% of 0.56 (95%CI:0.50-0.62) (p=0.049), and calculated with SaO2<90% of 0.60 (95%CI:0.54-0.66) (p=0.002). The ACOR for subjects classified as low-risk using the Geneva score, with a PERC calculated with SaO2<95%, was: 0.53 (95%CI:0.45-0.60) (p=0.459) and for a PERC calculated with SaO2<90% it was: 0.55 (95%CI:0.47-0.62) (P=0.218). The ACOR for subjects with a less than 10% probability of PE according to the Pisa score classification, with a PERC calculated with SaO2<95%, was: 0.54 (95%CI:0.44-0.64)(p=0.422), and for a PERC calculated with SaO2<90% it was: 0.56 (95%CI:0.46-0.66)(p=0.236). Conclusions: the PERC score calculated with an oxygen saturation <90% has a similar diagnostic yield to the PERC score calculated with an oxygen saturation <95% for ruling out PE in patients classified as low-risk by the Wells score at high altitudes (>2,500 meters ASL). (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.2010).

Rehabilitación oncológica en cardiotoxicidad: rompiendo paradigmas en la atención al sobreviviente de cáncer / Oncological rehabilitation in cardiotoxicity: Breaking paradigms in cancer survivorcare

Con avances progresivos en la detección y el tratamiento del cáncer, la supervivencia ha mejorado drásticamente en las últimas décadas. El cáncer y las enfermedades cardiovasculares son las principales causas de muerte en los países de ingresos altos. Se pueden encontrar complicaciones cardiovasculares en pacientes con cáncer como resultado de la denominada 'cardiototoxicidad'. Existe una serie de tratamientos contra el cáncer que se han asociado con diversos grados de lesión cardiovascular, los cuales pueden mostrar consecuencias cardiovasculares hasta años después de la finalización del tratamiento del cáncer. El desarrollo de disfunción cardíaca relacionada con el tratamiento del cáncer tiene un alto riesgo de morbilidad y mortalidad. La detección temprana de los factores de riesgo parece fundamental para prevenir enfermedades cardiovasculares a largo plazo. En esta revisión se analizaron los factores de riesgo de la terapia sistémica y la radioterapia como generadores de cardiototoxicidad

With progressive advances in cancer detection and treatment, survival has improved dramatically in recent decades. Cancer and cardiovascular disease are the leading causes of death in high-income countries. Cardiovascular complications can be encountered in cancer patients as a result of so-called 'cardiotoxicity'. There are a number of cancer treatments that have been associated with varying degrees of cardiovascular injury, which may show cardiovascular consequences up to years after completion of cancer treatment. The development of cardiac dysfunction related to cancer treatment has a high risk of morbidity and mortality. Early detection of risk factors appears critical to prevent long-term cardiovascular disease. In this review we analyzed the risk factors of systemic therapy and radiotherapy as generators of cardiototoxicity.

Telemedicina una alternativa de atención durante la pandemia por Covid-1 / Telemedicine an alternative for medical practice during the Covid-19 pandemic. Review Article

La aparición de la pandemia por Covid-19, su alto contagio e impacto en la salud de poblaciones vulnerables y la necesidad de distanciamiento social, obligó a adaptar rápidamente los procesos de atención ambulatoria a pacientes por medio de herramientas tecnológicas con eventos de atención no presencial (teleconsulta). El propósito de este artículo es revisarla información más relevante sobre el uso de la telemedicina y su impacto actual

The emergence of the Covid-19 pandemic, its high contagion and impact on the health of vulnerable populations and the need for social distancing, forced the rapid adaptation of outpatient care processes by means of technological tools with non-face-to-face care events (teleconsultation). The purpose of this article is to review the most relevant information on the use of telemedicine and its current impact.

Compromiso del Sistema Nervioso Periférico en la infección por Sars-CoV-2 / Peripheral Nervous System involvement in Sars-CoV-2 infection

En diciembre de 2019 en China, inicia una de las pandemias más complejas del último siglo. En efecto, la infección por Sars-CoV-2 o Covid-19, como fue denominada por la Organización Mundial de la Salud, es sin duda una emergencia en salud pública que ha requerido implementar modificaciones de los sistemas de salud en el mundo para su atención. Los síntomas respiratorios son la base de las principales complicaciones de esta infección; sin embargo, se encuentra disponible información relevante sobre las manifestaciones neurológicas asociadas al Sars-CoV-2, en especial con relación al compromiso del sistema nervioso central (SNC); por el contrario, los estudios sobre el impacto del nervio periférico son más escasos. La presente revisión se centra en las manifestaciones neurológicas periféricas asociadas al Covid-19.

In December 2019 in China, one of the most complex pandemics of the last century begins. Indeed, the Sars-CoV-2 or Covid-19 infection, as it was named by the World Health Organization, is undoubtedly a public health emergency that has required the implementation of modifications in the world's health systems for its care. Respiratory symptoms are the basis of the main complications of this infection; however, relevant information is available on the neurological manifestations associated with Sars-CoV-2, especially in relation to central nervous system (CNS) involvement; in contrast, studies on the impact of the peripheral nerve are scarcer. The present review focuses on the peripheral neurological manifestations associated with Covid-19.

Severity of Depressive Symptoms Pre- and Postcardiac Rehabilitation: A COMPARISON AMONG PATIENTS IN BRAZIL, CANADA, COLOMBIA, THE UNITED STATES, AND VENEZUELA.

PURPOSE: Depression is 3 times more prevalent in the cardiac than the general population in high-income countries and is particularly high in middle-income countries. Comorbid depression is associated with twice the mortality after a cardiovascular event. The objectives of this study were to describe and compare depressive symptoms pre- and postcardiac rehabilitation (CR) among patients in high-income countries and middle-income countries in the Americas. METHODS: The study design was prospective and observational. A convenience sample of CR participants completed the Patient Health Questionnaire-9 (PHQ-9) at CR intake and again at program discharge. Clinical data were extracted from medical charts. RESULTS: There were 779 participants: 45 Brazilian (5.8% of sample), 214 Canadian (27.5%), 126 Colombian (16.2%), 309 American (39.7%), and 85 Venezuelan (10.9%). Pre-CR depressive symptoms significantly differed between countries (P < .05), with Colombian participants reporting higher scores than Canadians and Venezuelans. Total PHQ-9 scores significantly decreased during CR in Colombia (mean change =-2.33; P < .001), the United States (mean change =-1.12; P < .001), and Venezuela (mean change =-2.14; P < .001), but not in Brazil (where less psychosocial intervention was offered) or Canada (where pre-CR scores were low). Among the 102 (13.1%) participants with scores in the elevated range pre-CR, the mean change in PHQ-9 scores was -6.57 ± 1.09 and 40 (39.2%) participants no longer had elevated symptoms postprogram. CONCLUSIONS: Depressive symptoms are variable among patients with CR in South and North American countries. CR programs incorporating psychosocial components can reduce these symptoms.

Relación entre el cambio organizacional y la actitud al cambio en trabajadores de una empresa de Bogotá / Relations Between Organizational Change and Attitude Towards Change in Workers Of An Organization In Bogotá

El objetivo de esta investigación fue encontrar la relación existente entre el cambio organizacional y la actitud hacia el cambio, en los trabajadores de una empresa de Bogotá. Se realizó bajo un estudio de tipo transversal correlacional, mediante la aplicación del Instrumento de Medición de cambio (IMC) y la escala de actitudes hacia el cambio (EAC). Para ello, se tomó una muestra a 50 funcionarios y se les aplicaron los dos instrumentos. en los resultados se obtienen correlaciones significativas entre la variable de temor del instrumento EAC y las variables participación (integración) (r = -.375), comunicación (r = -.518), trabajo en equipo (r = -.590), aceptación (r = -.369), conocimiento de la organización (r = -.497), cultura de cambio (r =-.429), proyección y desarrollo del cambio (r = -.650), nivel grupal (r = -.579,) del instrumento IMC. Por otro lado, se encontró una relación entre la variable cinismo del instrumento EAC y las variables adaptabilidad (r = -.488), participación (integración) (r = -.538), comunicación (r = -.518), trabajo en equipo (r = -.661), aceptación (r = -.546), conocimiento de la organización (r = -.645) cultura de cambio (r = -.398), gestión del cambio (r =-.481), proyección y desarrollo del cambio (r = -.685), nivel individual (r = -.390), nivel grupal (r = -.667), nivel organizacional (r = -.599) del IMC. Se concluye que los empleados de la organización manifestaron una actitud de favorabilidad y flexibilidad hacia el cambio.

The objective of this research was to find the relationship between organizational change and attitude change among workers in a company in Bogota. It was conducted under a cross-sectional correlational study, by applying the measuring instrument of change (BMI) and the range of attitudes towards change (EAC). To this end, a sample of 50 officers was taken and we applied the two instruments. In the results significant correlations are obtained between the variable of fear of the CAD tool and participation variables (integration) (r =-.375), communication (r =-.518), work (r =-.590), acceptance (r =-.369), knowledge of the organization (r =-.497), culture of change (r =-.429), design and development of change (r = -.650), group level (r = -.579), the instrument IMC. On the other hand, we found a variable relationship between EAc and cynicism of the instrument adaptability variables (r =-.488), participation (inclusion) (r =-.538), communication (r =-.518), work team (r = -.661), acceptance (r = -.546), knowledge of the organization (r = -.645), culture of change (r = -.398), management of change (r = -.481 ), design and development of change (r= -.685), individual level (r = -.390), group level (r = -.667), organizational level (r = -.599) of the IMC. We conclude that employees of the organization, had a favorability and flexible attitude towards change.

Pronóstico de la enfermedad de Hodgkin en pacientes de la I y III Cátedra de Clínica Médica del Hospital de Clínicas. Periodo 2000-2009 / Prognosis Hodgkin's disease in patients with the I and III of the Chair of Clinical Medical Clinic Hospital. 2000-2009 period

Introducción: La enfermedad de Hodgkin es poco común, se la considera potencialmente curable, por lo que se asocia con varios factores pronóstico que determinan su tratamiento. Objetivo: Establecer el pronóstico de la enfermedad de Hodgkin en pacientes que asisten a los Servicios de Clínica Médica del Hospital de Clínicas en el periodo 2000 al 2009. Diseño: Observacional, descriptivo, de corte transverso, retrospectivo, fuente secundaria de pacientes que asisten en la I y III Cátedra de Clínica Médica. Intervenciones: Revisión sistemática de Historias Clínicas de los pacientes asistidos en el Servicio mencionado, en el periodo 2000 al 2009. Resultados: El 89% de los pacientes resultaron con pronóstico mayor al 50% de sobrevida en 5 anos, a pesar de que 65% se diagnosticaron en estadio IV. El pronostico de los pacientes de sexo masculino y en los mayores a 45 anos fue de 42% de sobrevida en 5 anos. Conclusión: Se comprobó que los factores de peor pronóstico fueron sexo masculino y la edad mayor a 45 años, mientras que los síntomas B se presentaron en alta frecuencia y los demás con frecuencia menor

Antimicrobial efficacy of medicated root canal filling materials.

Bacteria remaining within the root canal system are a significant factor in endodontic failures. The aim of this in vitro study was to evaluate the antimicrobial efficacy of commercially available gutta-percha formulations against common endodontic pathogens. Standard, tetracycline, or iodoform (also called medicated gutta-percha; MGP) containing gutta-percha were tested against Actinomyces israelii, A. naeslundii, Enterococcus faecalis, and Fusobacterium nucleatum using the agar diffusion method. Resilon points and tetracycline disks/E-tests were used as negative and positive controls, respectively. Resilon did not display antimicrobial properties. Standard gutta-percha and MGP inhibited F. nucleatum and A. naeslundii, with MGP also inhibiting A. israelii. Tetracycline containing gutta-percha was found to inhibit growth from all four bacterial species tested. The results of this study suggest that the use of tetracycline containing gutta-percha as an obturation material may be useful as a complement to the cleaning and disinfection phase of root canal procedures.

Correlación entre las unidades formadoras de colonias (UFCs) y la experiencia de caries / Correlation beween colony-forming units (CFUs) and caries experience

Objetivo: Comprobar la relación entre el número de unidades formadoras de colonias (UFCs) de Streptococcus mutans y Lactobacillus, medido por medio de la prueba CRT-Bacteria (Vavadent/Ivoclar), y la experiencia de caries, teniendo en cuenta los índices de caries COP y coe. Método: La muestra, de origen multicéntrico y escogida intencionalmente, consistió en 80 pacientes, 40 por género, quienes fueron agrupados según ocho criterios de inclusión (niños sin erupción dental, adultos desdentados, pacientes con COP=0, pacientes con coe=0, pacientes con caries de mancha balnca, pacientes con cavitación, y pacientes con obturaciones de más de un año sin caries). La presentación de los resultados se hizo con estadísticas descriptivas, medidas de tendencia central y de dispersión, y la asociación entre las variables se analizó mediante las pruebas U de Mann Whitney y RHO de Spearman. Resultados: El género no mostró correlación con los índices de caries ni con el recuento de las UFCs de S mutans y Lactobacillus, (p>0,43). Por el contrario, la edad sí evidenció correlación estadísticamente significativa con el recuento de microorganismos (p<0,0). Conclusiones: No se halló relación entre los índices de caries y el recuento de microorganismos, mostrando poca sensibilidad de la pueba como para aplicarla en actividades de salud pública dental (p>0,33)