Bundles reduce anastomosis leak in patients undergoing elective colorectal surgery. A propensity score-matched study.

Background: anastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyse the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle. Methods: Single-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bundle. Results: The bundle group shown fewer complications, especially in Clavien Dindós Grade IV complications (2.3% vs. 6.2% p < 0.01), as well as a lower rate of anastomotic leakage (15.5% vs. 2.2% p < 0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p > 0.05). Conclusions: The implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions. Register study: The study has been registered at clinicaltrials.gov Code: nct04632446.

Initial orientation vs maintenance of attention: Relationship with the severity of dependence and therapeutic outcome in a sample of cocaine use disorder patients.

The visual probe paradigm allows for evaluating attentional bias (AB), distinguishing between approach vs avoidance patterns of attention and assessing two different processes when the exposure time to images is manipulated: initial orienting and maintenance of attention. The present study aimed to analyze the predictive capacity of these two processes for substance use disorder severity and therapeutic outcomes of patients with cocaine use disorder in treatment. The sample consisted of 70 outpatients who were starting treatment at a public service. AB was evaluated using a task based on the visual probe (VP) paradigm with images presented under two conditions: 200 ms vs 1000 ms. Cocaine and alcohol use disorder severity, craving, retention in treatment and relapse in consumption were recorded. Cocaine AB in the 1000 ms condition was negatively correlated with the cocaine use disorder severity (r = -0.26), whilst a positive correlation was found between cocaine craving and cocaine AB (r = 0.29). Alcohol use disorder severity negatively correlated with cocaine AB in the 200 ms condition (r = -0.24). Logistic regression analysis revealed that, after controlling for gender, age, and substance use disorder severity, cocaine AB in the 200 ms condition predicted dropout and relapse. Our results suggest that patients who adhere to treatment and remain abstinent tend to show avoidance in the 200 ms condition, with effect sizes of r = 0.29 and 0.30 respectively. The results suggest that training in avoidance strategies could be a valuable way of maintaining adherence and abstinence, as well as improving control of craving.

The global prevalence of apical periodontitis: a systematic review and meta-analysis.

BACKGROUND: Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. OBJECTIVES: To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. METHODS: A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. RESULTS: The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2  = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2  = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2  = 98.5%) and 3% (95% CI 2%-3%; I2  = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2  = 97.8%) and hospitals (51%; 95% CI 40%-63%; I2  = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2  = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2  = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2  = 98.3%). DISCUSSION: The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. CONCLUSIONS: Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.

Susceptibility of entomopathogenic nematodes to ivermectin and thiabendazole.

The objective of the present study was to determine the susceptibility of entomopathogenic nematodes to ivermectin and thiabendazole. Soil samples collected from the municipalities of Irapuato and León, Guanajuato, Mexico, were obtained, from which the entomopathogenic nematodes (EPNs) of the Steinernematidae and Heterorhabditidae families were isolated. The samples were classified from livestock and nonlivestock soils, and the susceptibility of EPNs to anthelmintics was determined with the larval motility assay (LMA, 24 h) and the larval migration inhibition assay (LMI assay, 48 h). Sterile distilled water (T1) and treatments with 1% ivermectin diluted in 5% DMSO (dimethyl sulfoxide) (T2) and 5% thiabendazole diluted in 5% DMSO (T3) were applied to infective juvenile larvae. Analysis of variance was performed with a factorial design and Tukey's test at 0.05 probability. In addition, different concentrations of ivermectin (0.1, 0.5, 1, 1.2, 1.5, and 2 µg) and thiabendazole (1, 5, 10, 12, 15, and 20 mg) were evaluated to perform a Probit analysis to determine their LC50. All strains of EPNs were susceptible to ivermectin in both the LMA and LMI assay. The results show that EPNs are susceptible to ivermectin and thiabendazole, and the degree depends on the type of test performed, the chemical product used, and the origin of the strain of EPN.

The Mexican consensus on the treatment of hepatitis C. / Consenso Mexicano para el Tratamiento de la Hepatitis C.

The aim of the Mexican Consensus on the Treatment of HepatitisC was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitisC treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

Novel technique of temporary abdominal closure with continuous medial fascial traction dynamic for patients with open abdomen.

Open abdomen has been an effective treatment for abdominal catastrophes in trauma and general surgery, is one of the greatest advances in recent decades and has become a common procedure in both trauma and general surgery. Temporary abdominal closure techniques in managing open abdomen help to achieve many benefits without incurring many complications. We present a series of patients in which a temporary abdominal closure technique was used that generates continuous medial fascial traction dynamic in patients with open abdomen for different causes.

[Plantar pressure platform as clinical assesment tool in the analysis of foot posture with the foot posture index]. / Die Druckmessplattform als klinisch-diagnostisches Instrument zur Analyse der Fußstatik nach dem Foot Posture Index.

BACKGROUND: The foot posture index is a static measurement that splits up the foot posture into neutral, pronatus and supinatus. However, the relation between the foot posture and the plantar pressure standards is not well known. For this, the objective of this research is to check the relationship between the foot posture and plantar pressure standard. SUBJECTS AND MATERIAL: 144 participants (101 women and 43 men), mean age 25.4 ± 6.3 years, were measured for the FPI. The pedobarometric measurement was made with the plantar pressure platform, we measured total surface (cm2), mean pressure (kPa) and maximum pressure (kPa), these measurements were correlated with the FPI measurements. RESULTS: 288 feet were analysed with regard to the correlation between point 5 of FPI (medial arch height) and the plantar surface total area (p = 0.038): lower arch height and supinated foot are related to the maximum pressure points with p = 0.029. The total contact surface can be determined with the final score of the FPI, the scores of FPI 3, 5 and 6 FPI (r2 = 0.059, p < 0.001) with a 5.9 % prediction. CONCLUSION: The supinatus foot is correlated statistically significantly through the maximum pressure and the plantar surface with the pronatus foot.

[History of epistaxis since the ancient times to the first half of the XXth century]. / Historia de la epistaxis desde la antigüedad clásica hasta la primera mitad del siglo XX.

Epistaxis is one of the more frequent entities in the otolaryngological practice. The term is attributed to CULLEN (1785). Since them, multiple theories concerning etiology, clinical manifestacions, diagnosis and management have been reported in the medical literature. Nevertheless, an impressive improvement of awareness about these questions have emerged in the last half of past century. The objective of this work is to revise the history of epistaxis since the ancient times to the first half of the 20th century.

Bioremediation of oil refinery sludge by landfarming in semiarid conditions: influence on soil microbial activity.

Bioremediation of a refinery sludge containing hydrocarbons in a semi-arid climate using landfarming techniques is described. The objective of this study was to assess the ability of this technique to reduce the total hydrocarbon content added to the soil with the refinery sludge in semiarid climate (low rain and high temperature). In addition, we have evaluated the effect of this technique on the microbial activity of the soil involved. For this, biological parameters (carbon fractions, microbial biomass carbon, basal respiration and ATP) and biochemical parameters(different enzymatic activities) were determined. The results showed that 80% of the hydrocarbons were eliminated in eleven months, half of this reduction taking place during the first three months. The labile carbon fractions, MBC, basal respiration and ATP of the soils submitted to landfarming showed higher values than the control soil during the first months of the process, although these values fell down by the end of the experimental period as the hydrocarbons were degraded by mineralisation. All the enzymatic activities studied: oxidoreductases such as dehydrogenase activity, and hydrolases of C(beta-glucosidase activity) and N Cycle (urease and protease) showed higher values in the soils amended with the refinery sludge than in the control. As in the case of the previous parameters, these value fell down as the bioremediation of the hydrocarbons progressed, many of them reaching levels similar to those of the control soil after eleven months.

[The functional independence of lexical numeric knowledge and the representation of magnitude: evidence from one case]. / Independencia funcional del conocimiento numérico léxico y la representación de la magnitud: evidencia de un caso.

INTRODUCTION: The ultimate purpose of cognitive neuropsychology is to find out how normal cognitive processes work. To this end, it studies subjects who have suffered brain damage but who, until their accident, were competent in the skills that are later to become the object of study. It is therefore necessary to study patients who have difficulty in processing numbers and in calculating in order to further our knowledge of these processes in the normal population. AIMS: Our aim was to analyse the relationships between the different cognitive processes involved in numeric knowledge. CASE REPORT: We studied the case of a female patient who suffered an ischemic infarct in the perisylvian region, on both a superficial and deep level. She presented predominantly expressive mixed aphasia and predominantly brachial hemiparesis. Numeric processing and calculation were evaluated. The patient still had her lexical numeric knowledge but her quantitative numeric knowledge was impaired. These alterations in the quantitative numeric knowledge are evidenced by the difficulties the patient had in numeric comprehension tasks, as well as the severe impairments displayed in calculation. CONCLUSIONS: These findings allow us to conclude that quantitative numeric knowledge is functionally independent of lexical or non-quantitative numeric knowledge. From this functional autonomy, a possible structural independence can be inferred.

[Numerical and calculation processing: evidence for a case from cognitive neuropsychology]. / Procesamiento numérico y cálculo: evidencia de un caso desde la neuropsicología cognitiva.

INTRODUCTION: This paper, which deals with cognitive Neuropsychology, attempts to contribute to the understanding of normal cognitive processing by examining and analysing the deficits acquired by individuals who have suffered brain damage. AIMS: Our aim was to analyse the different cognitive processes involved in numerical processing (NP) and in calculation, together with the relations between them. PATIENTS AND METHODS: A quadriplegic patient with sequelae that include motor aphasia and deep dysgraphia as the residual pathologies of a traumatic brain injury, with a history of over four years; language comprehension is preserved (both oral and written) and there is no verbal expression whatsoever. Expression is achieved functionally by means of a specially adapted laser pointer. Assessment of NP and calculation was performed. RESULTS: Alterations were observed in the calculation system, one in the recognition of arithmetical signs and the other in the execution of arithmetical operations. CONCLUSIONS: 1. Calculation skills are independent of those required to perform numerical recoding and of lexical or encyclopaedic numerical knowledge. 2. Recognition of arithmetical signs is independent of, and therefore dissociated from, data retrieval and the execution of calculation procedures. 3. Data retrieval processes and those required for the execution of calculations are independent. Therefore, the calculation system consists of different elements that are independent from one another.

Los nuevos factores de riesgo cardiovascular / The new cardiovascular risk factors

En esta revisión se definen las características y criterios epidemiológicos de los factores de riesgo cardiovascular (FRCV), su clasificación según su importancia y la posibilidad de intervención, su tendencia a asociarse entre sí y la multiplicación del riesgo que ello entraña. De entre los llamados "nuevos FRCV", se analizan la reactividad cardiovascular, el fibrinógeno, la microalbuminuria, la homocisteína y la lipoproteína (a). En el estudio de la reactividad cardiovascular se definen los tipos de estresores y la respuesta hemodinámica al estrés. Se detalla la relación de la reactividad cardiovascular como factor desencadenante de hipertensión arterial (HTA). Respecto del fibrinógeno, se analizan las evidencias científicas y epidemiológicas que lo avalan como FRCV y se detallan los factores que modifican su tasa. Sobre la microalbuminuria se definen y pormenorizan los métodos de su determinación, así como su importante relación con la diabetes y la HTA. Se expone la fisiopatología de la hiperhomocisteinemia, así comos sus causas y correlación con la enfermedad cardiovascular, su detección y posible tratamiento y control. Referido a la lipoproteína (a), se analiza su metabolismo y los factores que influyen sobre su concentración. Se repasan sus funciones fisiológicas y su relación con la cardiopatía coronaria (AU)

Hipertensión en el anciano / Hypertension in the elderly

En la primera parte de la revisión se establecen los criterios y definiciones de hipertensión ajustada a la edad. Asimismo se revisa la fisiopatología del envejecimiento vascular y orgánico. Se establecen una serie de normas para un correcto registro de la presión arterial del anciano y evitar los errores desencadenados por el "pozo auscultatorio" y la pseudohipertensión. En el apartado terapéutico se recomiendan las cifras de presión sistólica y diastólica a conseguir según las cifras iniciales. Se analizan los grandes ensayos terapéuticos de intervención (SYST-EUR, MRC, STOP, EWPHE, SNEP, MONICA, THOMS, HOT, HYET) que demuestran una clara disminución de la morbimortalidad cardiovascular. En los individuos de alto riesgo cardiovascular lo más adecuado será el tratamiento farmacológico. Los diuréticos a dosis bajas serían los fármacos de elección. Los antagonistas del calcio tipo dihidropiridinas de acción prolongada pueden resultar útiles en muchos pacientes. Cabe mencionar, por último, que se irán acumulando más evidencias acerca de la bondad de los inhibidores de la enzima de conversión de la angiotensina y antagonistas de los receptores de angiotensina (ARAS) en la población anciana. Este planteamiento nos lleva una vez más a aceptar la individualización terapéutica para cada caso en particular (AU)

Relation of serum cholesterol, lipid, serotonin and tryptophan levels to severity of depression and to suicide attempts.

OBJECTIVE: To determine if there is a relation to low serum cholesterol, lipoprotein, serotonin or tryptophan levels in patients with depression who have recently attempted suicide. DESIGN: Biochemical and behavioural study. SETTING: Inpatient and outpatient treatment at the Instituto Mexicano de Psiquiatría. PARTICIPANTS: Thirty-three patients with a diagnosis of major depressive episode. Eighteen of these patients had attempted suicide in the month before the start of the study; 15 patients had never attempted suicide. OUTCOME MEASURES: Serum levels of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, serotonin (5-HT) and tryptophan. Scores on Hamilton Depression Rating Scale, Carroll Depression Rating Scale, Beck Hopelessness Scale and Beck Suicide Attempt Severity Scale. RESULTS: There were no significant differences between patients who had attempted suicide and those who had not in terms of serum cholesterol, HDL, LDL and triglyceride levels. Serum levels of 5-HT and tryptophan were significantly lower in patients with depression who had a recent suicide attempt than in those patients who had never attempted suicide. A comparison of patients not taking antidepressant medication found serum 5-HT levels to be more than 3 times lower in those patients with a recent suicide attempt than in patients with no history of suicide attempt. CONCLUSIONS: The study found no difference in lipid profiles between patients who had attempted suicide and those who had not. Low serum levels of 5-HT may increase the risk of suicide attempt in patients who are depressed.

Excised rootstock roots cultured in vitro.

Root cultures have been established successfully for the Prunus rootstocks Adafuel and Adarcias (Prunus×amygdalopersica), A843 (P. armeniaca), Mariana 2624 (P. cerasifera×munsoniana) and Myrobalan 605AD (P. cerasifera), and for the apple rootstock Jork 9 (Malus×domestica). High percentages of root tips grew during the first 15 days and then decreased. Root growth was affected by culture conditions and the composition of the culture medium. Liquid medium was preferable as increasing agar concentrations reduced root growth. Darkness, instead of a 16-h photoperiod, was beneficial for Adafuel, but not the other genotypes. Sucrose at 3% was better than higher concentrations. Full Murashige and Skoog salts sustained better root growth than dilutions to 1/2 or 1/4. The addition of various organic supplements such as coconut water, casein hydrolysate or malt extract did not improve root growth, and sucrose was the best carbon source tested. Data presented here support the notion that excised root culture is an efficient experimental model to study the response to various factors, since controlled variations in the culture medium, such as those studied here, had a very noticeable effect on root length.

[Neuroandrologic considerations in impotent patients with Peyronie's disease]. / Consideraciones neuroandrológicas en pacientes impotentes con enfermedad de Peyronie.

OBJECTIVE: To asses the neuroandrologic profile of impotent patients with Peyronie's disease. METHODS: We conducted a pharmacological erection test and a study of the neuroandrologic profile of 13 impotent patients with Peyronie's disease. Eight patients hhad associated conditions and no associated disease was demonstrated in the remaining 5 patients. The neuroandrologic profile was based on bulbocavernous EMG, S2-S4 evoked potentials, somatosensorial potentials of pudendal nerve, cavernous smooth muscle electromyography (SPACE), sympathetic skin response, and cystometrogram. RESULTS: SPACE was altered in all the cases. In the patients with no associated disease, all other data of the neuroandrologic profile were normal. Patients with associated conditions demonstrated more alterations in all other data of the neuroandrologic profile and significant differences were observed in 7 cases. No differences in the type of alterations of SPACE were observed in 7 cases. No differences in the type of alterations of SPACE were observed between both groups. CONCLUSION: The impotence associated with Peyronie's disease could be due to an intrinsic lesion of the erectile smooth muscle.

[The health belief model. A theoretical approach to the prevention of AIDS]. / El modelo de creencias de salud. Un enfoque teórico para la prevención del SIDA.

Despite recent drug developments, the best available strategy we have today against HIV/AIDS is still preventive education. Since a voluntary behavioral change is difficult to achieve, even under the best possible conditions, preventive-education interventions should consider any strategy that facilitates the process of change. Although the final objective is to adopt a specific behavior, theoretical models that include cognitive-perceptive components can be useful in achieving that objective. It has been proven that a certain amount of information, even if not sufficient for sustaining behavior change, is an important predisposing component of initiating behavior changes. This paper examines the role of the Health Belief Model (HBM) as an educational tool for HIV/AIDS preventive interventions, and supports the use of social-cognitive theories in health education.

[Self-limited steatorrhea and chronic autoimmune hepatitis type I. The Group for the Study of Viral Hepatitis and AIDS]. / Esteatorrea autolimitada y hepatitis crónica autoinmune tipo I. Grupo para el Estudio de la Hepatitis Vírica y SIDA.

Active chronic hepatitis is very infrequent in Spain. Its autoimmune pathogenesis is supported by the coexistence of autoimmune features, its usually good response to immunosuppressive treatment and the frequent coexistence of other processes of autoimmune etiology. The infrequent cases of steatorrhea observed may usually be found in the presence of severe colostasis or in association with other diseases such as celiac disease. The presence of sever anemia is also infrequent being observed on hemolysis of digestive bleeding. A case of autoimmune type I chronic hepatitis observed in a 14-year old woman presenting as acute hepatitis associated to severe anemia (Hb, 6,3 g/dl) and self-limited steatorrhea independent of the clinical course of the hepatic picture (stool fats of up to 100 g/24 h) with no evidence of hemolysis, digestive bleeding, obvious colostasis, drug ingestion or demonstrable intestinal or pancreatic disease. The coexistence of these unusual findings led the authors to report this case.