Complicaciones quirúrgicas: un tema complicado / Surgical complications: A complicated topic

Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.

Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.

Acoso laboral y sexual en residentes de cirugía colombianos en 2023 / Workplace and sexual harassment among Colombian surgical residents during 2023

Introducción. El acoso laboral y sexual son problemas latentes durante la formación de los cirujanos, que conllevan repercusiones negativas a nivel individual, organizacional y del sistema sanitario. El objetivo del presente estudio fue explorar la prevalencia de estos tipos de acoso en residentes de cirugía colombianos. Métodos. Estudio nacional, de corte transversal, realizado en los veinte programas de residencia del país en septiembre de 2023. Los residentes autoevaluaron su exposición a ambas formas de acoso mediante cuestionarios validados. Se realizaron comparaciones entre víctimas y no víctimas de acoso, en función de las características demográficas de la población. Se evaluó la frecuencia de conductas de acoso laboral cometidas por diferentes perpetradores. Resultados. Se incluyeron 238 residentes (64,7 % del total de la población). Las tasas de acoso laboral y sexual fueron de 35,3 % y 18,1 %, respectivamente. Ambos tipos de acoso fueron significativamente mayores en los programas ubicados en el centro del país. El acoso sexual fue significativamente mayor entre las mujeres. Los profesores de cirugía y los residentes de niveles superiores fueron los principales perpetradores de conductas de acoso laboral. Conclusiones. El acoso laboral y sexual es altamente prevalente en la formación de los cirujanos colombianos. Estos hallazgos deben alertar a profesores, médicos residentes y otros grupos de interés, para fomentar ambientes y cultura educativa saludables, que permitan disminuir la prevalencia de estos comportamientos.

Introduction. Workplace and sexual harassment are latent problems during surgical training, which have negative repercussions at the individual, organizational and health system levels. The objective of the present study was to explore the prevalence of these types of harassment in all Colombian surgical residents. Methods. National cross-sectional study conducted in twenty residency programs in September 2023. Residents self-assessed their exposure to both forms of harassment using validated questionnaires. Comparisons were made between victims and non-victims of bullying, based on the demographic characteristics of the population. The frequency of workplace harassment behaviors committed by different perpetrators was evaluated. Results. A total of 238 residents were included (64.7% of population). Rates of workplace and sexual harassment were 35.3% and 18.1%, respectively. Both types of harassment were significantly higher in programs located in the central region of the country. Sexual harassment was significantly higher among women. Surgery professors and senior residents were the main perpetrators of workplace bullying behaviors. Conclusions. Workplace and sexual harassment is highly prevalent during surgical training of Colombian surgeons. These findings should alert professors, residents, and other interest groups to promote healthy educational environments and culture, which will reduce the prevalence of these behaviors.

Fortaleciendo la experticia adaptativa en la educación quirúrgica: un enfoque integral y estratégico / Strengthening adaptive expertise in surgical education: A comprehensive and strategic approach

Introducción. La formación integral de los residentes excede el conocimiento teórico y la técnica operatoria. Frente a la complejidad de la cirugía moderna, su incertidumbre y dinamismo, es necesario redefinir la comprensión de la educación quirúrgica y promover capacidades adaptativas en los futuros cirujanos para manejar efectivamente el entorno. Estos aspectos se refieren a la experticia adaptativa. Métodos. La presente revisión narrativa propone una definición de la educación quirúrgica con énfasis en la experticia adaptativa, y un enfoque para su adopción en la práctica. Resultados. Con base en la literatura disponible, la educación quirúrgica representa un proceso dinámico que se sitúa en la intersección de la complejidad de la cultura quirúrgica, del aprendizaje en el sitio de trabajo y de la calidad en el cuidado de la salud, dirigido a la formación de capacidades cognitivas, manuales y adaptativas en el futuro cirujano, que le permitan proveer cuidado de alto valor en un sistema de trabajo colectivo, mientras se fortalece su identidad profesional. La experticia adaptativa del residente es una capacidad fundamental para maximizar su desempeño frente a estas características de la educación quirúrgica. En la literatura disponible se encuentran seis estrategias para fortalecer esta capacidad. Conclusión. La experticia adaptativa es una capacidad esperada y necesaria en el médico residente de cirugía, para hacer frente a la complejidad de la educación quirúrgica. Existen estrategias prácticas que pueden ayudar a fortalecerla, las cuales deben ser evaluadas en nuevos estudios.

Introduction. The comprehensive training of residents exceeds theoretical knowledge and operative technique. Faced with the complexity of modern surgery, its uncertainty and dynamism, it is necessary to redefine the understanding of surgical education and promote adaptive capabilities in future surgeons for the effective management of the environment. These aspects refer to adaptive expertise. Methods. The present narrative review proposes a definition of surgical education with an emphasis on adaptive expertise, and an approach for its adoption in practice. Results. Based on the available literature, surgical education represents a dynamic process that is situated at the intersection of the complexity of surgical culture, learning in the workplace, and quality in health care, aimed at training of cognitive, manual, and adaptive capacities in the future surgeon, which allow them to provide high-value care in a collective work system, while strengthening their professional identity. Resident's adaptive expertise is a fundamental capacity to maximize his or her performance in the face of these characteristics of surgical education. In the available literature there are six strategies to strengthen this capacity. Conclusion. Adaptive expertise is an expected and necessary capacity in the surgical resident to deal with the complexity of surgical education. There are practical strategies that can help strengthen it, which must be evaluated in new studies.

El cirujano general en las urgencias hepatobiliares en Colombia desde la visión de los expertos: un estudio cualitativo / The general surgeon in hepatobiliary emergencies in Colombia from the experts' perspective: A qualitative study

Introducción. El manejo perioperatorio de las urgencias hepatobiliares por parte del cirujano general es una competencia esperada y se considera un reto por su relativa frecuencia, impacto en la salud del individuo y la economía, así como las implicaciones en el ejercicio clínico confiable y de alta calidad. Se desconocen los aspectos formales de la educación en cirugía hepatobiliar para el cirujano general en Colombia. El objetivo del presente estudio fue explorar la perspectiva de los cirujanos hepatobiliares sobre esta problemática. Métodos. Se realizó un estudio cualitativo, mediante entrevistas semiestructuradas con 14 especialistas en cirugía hepatobiliar colombianos, en donde se exploraron los desafíos del entrenamiento, el tiempo y las características de una rotación, la evaluación de la confiabilidad, el número de procedimientos y el rol de la simulación. Se hizo un análisis temático de la información. Resultados. Los expertos mencionaron la importancia de la rotación obligatoria por cirugía hepatobiliar para los cirujanos en formación. El tiempo ideal es de tres meses, en el último año de residencia, en centros especializados, con exposición activa y bajo supervisión. Conclusiones. Por las características epidemiológicas del país y la frecuencia de enfermedades hepatobiliares que requieren tratamiento quirúrgico, es necesario que el cirujano general cuente con una formación sólida en este campo durante la residencia. El presente estudio informa sobre las características ideales del entrenamiento en este campo desde la visión de los expertos colombianos.

Introduction. The perioperative management of hepatobiliary emergencies by the general surgeon is an expected competence and is considered a challenge due to its relative frequency, impact on the individual health and the economy, as well as the implications for reliable and high-quality clinical practice. The formal aspects of education in hepatobiliary surgery for the general surgeon in Colombia are unknown. The objective of the present study was to explore the perspective of hepatobiliary surgeons on this problem. Methods. A qualitative study was carried out through semi-structured interviews with 14 Colombian hepatobiliary surgery specialists, where the challenges of training, time and characteristics of the rotation, evaluation of reliability, number of procedures and role of simulation. A thematic analysis of the information was carried out. Results. The experts mentioned the importance of mandatory rotation for hepatobiliary surgery for surgeons in training. The ideal duration was three months, during the last year of residency, in specialized centers with active exposure and under supervision. Conclusions. Due to the epidemiological characteristics of the country and the frequency of hepatobiliary diseases that require surgical treatment, it is necessary for the general surgeon to have solid training in this field during residency. The present study reports on the ideal characteristics of training in this field from the perspective of Colombian experts.

Diagnostic utility of the Alvarado scale in older adults with suspected acute appendicitis.

BACKGROUND: Acute appendicitis remains as a differential diagnosis in older patients with abdominal pain. The Alvarado scale may assist to guide the diagnosis and treatment of this entity. The operative characteristics of the scale are little known in this population. METHOD: We conducted a systematic review of original studies published between 1986 and 2022 evaluating the diagnostic performance of the Alvarado scale in older adults with suspected acute appendicitis. The review was conducted according to the PRISMA statement. The evaluation of the methodological quality of the studies was performed according to the ROBINS-I criteria. RESULTS: Four original studies of retrospective design including 480 patients were identified. The heterogeneity and poor methodological quality limited an aggregate statistical analysis (meta-analysis). The value of the ROC curve of the scale varies between 0.799 and 0.969. From the available studies, the value of the ROC curve is lower in comparison to the RIPASA scale and comparable to the Lintula scale. CONCLUSIONS: The evidence on the diagnostic performance of the Alvarado scale in older adults is limited. The poor methodological quality of the available studies calls for a prudent use of this tool in this population. Our findings offer opportunities for future research.

ANTECEDENTES: La apendicitis aguda es un diagnóstico diferencial en el adulto mayor con dolor abdominal. La escala de Alvarado se utiliza para orientar el diagnóstico y el tratamiento. Las características operativas de la escala son poco conocidas en este grupo de pacientes. MÉTODO: Revisión sistemática de estudios originales publicados entre 1986 y 2022 que evaluaron el rendimiento diagnóstico de la escala de Alvarado en adultos mayores con sospecha de apendicitis aguda, con base en la declaración PRISMA. La evaluación de la calidad metodológica de los estudios se realizó con los criterios ROBINS-I. RESULTADOS: Se identificaron cuatro estudios originales de diseño retrospectivo que incluyen 480 pacientes. La heterogeneidad y la baja calidad metodológica limitaron un análisis estadístico agregado (metaanálisis). El valor de la curva ROC de la escala varía entre 0.799 y 0.969. En los estudios disponibles, el valor de la curva ROC es inferior al de la escala RIPASA y similar al de la escala de Lintula. CONCLUSIONES: La evidencia que sustenta el rendimiento diagnóstico de la escala de Alvarado en los adultos mayores es limitada. La pobre calidad de los estudios disponibles advierte sobre el uso prudente de esta herramienta en este grupo poblacional. Los hallazgos identificados ofrecen oportunidades de investigación futura.

Transport of non-classical light mediated by topological domain walls in a SSH photonic lattice.

Advancements in photonics technologies have significantly enhanced their capability to facilitate experiments involving quantum light, even at room temperature. Nevertheless, fully integrating photonic chips that include quantum light sources, effective manipulation and transport of light minimizing losses, and appropriate detection systems remains an ongoing challenge. Topological photonic systems have emerged as promising platforms to protect quantum light properties during propagation, beyond merely preserving light intensity. In this work, we delve into the dynamics of non-classical light traversing a Su-Schrieffer-Heeger photonic lattice with topological domain walls. Our focus centers on how topology influences the quantum properties of light as it moves across the array. By precisely adjusting the spacing between waveguides, we achieve dynamic repositioning and interaction of domain walls, facilitating effective beam-splitting operations. Our findings demonstrate high-fidelity transport of non-classical light across the lattice, replicating known results that are now safeguarded by the topology of the system. This protection is especially beneficial for quantum communication protocols with continuous variable states. Our study enhances the understanding of light dynamics in topological photonic systems and paves the way for high-fidelity, topology-protected quantum communication.

Efecto de la "ley de residentes" sobre el bienestar laboral en cirugía: resultados de un estudio nacional de métodos mixtos en Colombia / Effect of the "residents' law" on occupational well-being in surgery: Results of a national mixed methods study in Colombia

Introducción. El efecto de las políticas para el mejoramiento del bienestar de los residentes, en términos de desgaste profesional y compromiso laboral, es controversial y su resultado tras la implementación de la "ley de residentes" (1917/2018) en Colombia es desconocido. Este estudio explora el efecto de esta ley en médicos residentes de cirugía colombianos. Métodos. Estudio de métodos mixtos secuencial explicativo. Inicialmente, se invitó a todos los residentes de cirugía del país a autodiligenciar los cuestionarios UWES-17 y MBI-HSS para evaluar el compromiso laboral (vigor, dedicación y absorción) y desgaste profesional (agotamiento emocional, despersonalización y baja realización personal) antes (2019) y después (2022) de la implementación de la ley. Se probaron diferentes hipótesis mediante modelos de ecuaciones estructurales. Los resultados fueron explorados con cirujanos mediante grupos focales. La información cualitativa fue analizada manualmente y por inteligencia artificial, y reportada en temas principales. Resultados. Participaron en el estudio 400 residentes. La tasa de desgaste profesional fue de 24,8 % antes y 15,8 % después (p=0,032). El análisis de ecuaciones estructurales confirmó que el agotamiento emocional sobre el desgaste profesional fue menor en 2022 (p=0,022). No se identificaron cambios significativos en el compromiso laboral. La principal explicación fue atribuida a los beneficios económicos de la ley. Conclusión. La tasa de desgaste profesional en médicos residentes de cirugía colombianos se redujo significativamente tras la implementación de la "ley de residentes". Estos hallazgos tienen implicaciones para la practica y el mejoramiento de la calidad de la educación.

Introduction. The effect of policies to improve residents' well-being, in terms of professional burnout and work commitment is controversial, and its result after the implementation of the "residents' law" (1917/2018) in Colombia is unknown. This study explores the effect of this law on Colombian surgical residents. Methods. Explanatory sequential mixed methods study. Initially, all surgical residents in the country were invited to self-complete the UWES-17 and MBI-HSS questionnaires to evaluate work commitment (vigor, dedication, and absorption) and professional burnout (emotional exhaustion, depersonalization, and low personal accomplishment) before (2019) and after (2022) the implementation of the law. Different hypotheses were tested using structural equation models. The results were explored with surgeons through focus groups. Qualitative information was analyzed manually and by artificial intelligence, and reported into main themes. Results. 400 residents participated in the study. Burnout rates were 24.8% before and 15.8% after (p=0.032). The structural equations analysis confirmed that emotional exhaustion over professional burnout was lower in 2022 (p=0.022). No significant changes in work commitment were identified. The main explanation was attributed to the economic benefits of the law. Conclusion. The burnout rate in Colombian surgical residents was significantly reduced after the implementation of the "residents' law". These findings have implications for practice and improving the quality of education

Floquet Engineering of a Diatomic Molecule through a Bichromatic Radiation Field.

We report on a theoretical study of a Cs2 molecule illuminated by two lasers and show how this can result in novel quantum dynamics. We reveal that these interactions facilitate the bypass of the non-crossing rule, forming light-induced conical intersections and modifiable avoided crossings. Our findings show how laser field orientation and strength, along with initial phase differences, can control molecular-state transitions, especially on the micromotion scale. We also extensively discuss how the interaction of radiation with matter gives rise to the emergence of potential energy surfaces of hybrids of radiation and molecular states. This research advances a technique for manipulating photoassociation processes in Cs2 molecules, offering potential new avenues in quantum control.

Phosphatidylcholine-deficient suppressor mutant of Sinorhizobium meliloti, altered in fatty acid synthesis, partially recovers nodulation ability in symbiosis with alfalfa (Medicago sativa).

Rhizobial phosphatidylcholine (PC) is thought to be a critical phospholipid for the symbiotic relationship between rhizobia and legume host plants. A PC-deficient mutant of Sinorhizobium meliloti overproduces succinoglycan, is unable to swim, and lacks the ability to form nodules on alfalfa (Medicago sativa) host roots. Suppressor mutants had been obtained which did not overproduce succinoglycan and regained the ability to swim. Previously, we showed that point mutations leading to altered ExoS proteins can reverse the succinoglycan and swimming phenotypes of a PC-deficient mutant. Here, we report that other point mutations leading to altered ExoS, ChvI, FabA, or RpoH1 proteins also revert the succinoglycan and swimming phenotypes of PC-deficient mutants. Notably, the suppressor mutants also restore the ability to form nodule organs on alfalfa roots. However, nodules generated by these suppressor mutants express only low levels of an early nodulin, do not induce leghemoglobin transcript accumulation, thus remain white, and are unable to fix nitrogen. Among these suppressor mutants, we detected a reduced function mutant of the 3-hydoxydecanoyl-acyl carrier protein dehydratase FabA that produces reduced amounts of unsaturated and increased amounts of shorter chain fatty acids. This alteration of fatty acid composition probably affects lipid packing thereby partially compensating for the previous loss of PC and contributing to the restoration of membrane homeostasis.

Efecto de la deuda económica sobre el bienestar psicológico de los residentes de cirugía: Resultados de un estudio nacional en Colombia / Effect of financial debt on the psychological well-being of surgery residents: Results of a national study in Colombia

Introducción. La deuda económica durante la residencia en cirugía general puede afectar el desempeño profesional, las decisiones de vida y el bienestar psicológico. La información disponible en Colombia es limitada. El objetivo de este estudio fue cuantificar la deuda económica del residente de cirugía general, identificar los factores asociados y evaluar su efecto en el bienestar psicológico. Métodos. Estudio de corte transversal analítico. Se invitó a 380 residentes a diligenciar una encuesta sobre los aspectos relacionados con su deuda económica y se utilizó el WHO-index para evaluar su bienestar psicológico. Resultados. Un total de 259 residentes participaron en el estudio (67,6 %). El 56 % posee una deuda económica promedio de COP $88.000.000 ((US$21.826)). Un alto nivel de endeudamiento se relacionó con el año de residencia, el tipo de institución (privada) y la solicitud de préstamos. Se identificó algún trastorno mental en 14,7 % y un bajo nivel de bienestar psicológico en 56,4 % de los participantes. No se identificó ninguna asociación entre una elevada deuda económica y el bajo bienestar psicológico. Conclusiones. La deuda económica tiene un efecto sobre los residentes. El endeudamiento de los residentes de cirugía en Colombia es altamente prevalente, y no se correlaciona con un pobre bienestar psicológico. La autodeterminación favorece el bienestar psicológico en el posgrado en cirugía general. Existe la necesidad de educación financiera en los residentes. Se requieren nuevos estudios que evalúen las causas del pobre bienestar psicológico.

Introduction. Financial debt during surgery residency can affect professional performance, life decisions, and psychological well-being. The information available in Colombia is limited. The objective of this study is to quantify the financial debt of the general surgery resident, identify the associated factors and evaluate their effect on psychological well-being. Methods. A cross-sectional study was carried out. A total of 380 residents were invited to complete a survey on aspects related to their financial debt, and the WHO-index to evaluate their psychological well-being. Results. A total of 259 residents participated in the study (67.6%). 56% have an average economic debt of $88,000,000 COP (US$21,826). High debt was related to level of residence, type of institution (private), and loan application. Some mental disorder was identified in 14.7% and a low level of psychological well-being in 56.4% of the participants. No association was identified between high financial debt and low psychological well-being. Conclusions. Economic debt has an effect on residents. Financial debt among surgical residents in Colombia is highly prevalent; however, it does not correlate with poor psychological well-being. Self-determination favors psychological well-being in the postgraduate course in general surgery. Likewise, the need for financial education in residents is imminent. New studies are required that thoroughly evaluate the causes of poor well-being.

Reflexiones para optimizar el triaje en cirugía / Reflections to optimize triage in surgery

Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

Alcance para Colombia de la declaración de la World Society of Emergency Surgery 2022 sobre el entrenamiento en cirugía digestiva mínimamente invasiva de emergencia / Scope for Colombia of the World Society of Emergency Surgery 2022 declaration on training in emergency minimally invasive digestive surgery

Introducción. El currículo para la formación del cirujano general exige precisión, ajuste al contexto y factibilidad. En 2022, la World Society of Emergency Surgery formuló cinco declaraciones sobre el entrenamiento en cirugía digestiva mínimamente invasiva de emergencia que puede contribuir a estos propósitos. El objetivo del presente artículo fue examinar el alcance de estas declaraciones para la educación quirúrgica en Colombia. Métodos. Se analizó desde una posición crítica y reflexiva el alcance y limitaciones para Colombia de cada una de las declaraciones de la World Society of Emergency Surgery, con base en la evidencia empírica publicada durante las últimas dos décadas en revistas indexadas nacionales e internacionales. Resultados. La evidencia empírica producida en Colombia durante el presente siglo permite identificar que el país cuenta con fundamentos del currículo nacional en cirugía general, formulado por la División de Educación de la Asociación Colombiana de Cirugía en 2021; un sistema de acreditación de la educación superior; un modelo de aseguramiento universal en salud; infraestructura tecnológica y condiciones institucionales que pueden facilitar la adopción exitosa de dichas declaraciones para el entrenamiento de los futuros cirujanos en cirugía digestiva mínimamente invasiva de emergencia. No obstante, su implementación requiere esfuerzos mayores e inversión en materia de simulación quirúrgica, cooperación institucional y fortalecimiento del sistema de recertificación profesional. Conclusión. La educación quirúrgica colombiana está en capacidad de cumplir con las declaraciones de la World Society of Emergency Surgery en materia de entrenamiento en cirugía digestiva mínimamente invasiva de emergencia.

Introduction. The general surgeon training curriculum requires precision, contextual fit, and feasibility. In 2022, the World Society of Emergency Surgery formulated five statements on training in emergency minimally invasive digestive surgery, which can contribute to these purposes. This article examines the scope of these declarations for surgical education in Colombia. Methods. The scope and limitations for Colombia of each of the statements of the World Society of Emergency Surgery were analysed from a critical and reflective position, based on empirical evidence published during the last two decades in national and international indexed journals. Results. The empirical evidence produced in Colombia during this century allows us to identify that the country has the foundations of the national curriculum in general surgery, formulated by the Education Division of the Colombian Association of Surgery in 2021; a higher education accreditation system; a universal health insurance model; technological infrastructure, and institutional conditions that can facilitate the successful adoption of said statements for the training of future surgeons in emergency minimally invasive digestive surgery. However, its implementation requires greater efforts and investment in surgical simulation, institutional cooperation, and strengthening of the professional recertification system. Conclusion. Colombian surgical education is able to comply with the declarations of the World Society of Emergency Surgery regarding training in emergency minimally invasive digestive surgery.

Cerebrovascular Complications Associated With Iatrogenic Fungal Meningitis Following Surgical Procedures in Mexico.

BACKGROUND: The current fungal meningitis outbreak caused by contaminated epidural anesthesia with Fusarium solani among patients who underwent surgical procedures in Matamoros, Mexico remains a cause of concern. Its association with an increased susceptibility for cerebrovascular complications (CVC) has not been reported. This single-center study describes 3 patients with a unique pattern of CVC attributed to fungal meningitis. METHODS: A retrospective case series of patients diagnosed with fungal meningitis following surgical procedures under contaminated epidural anesthesia who developed a unique pattern of CVC during their hospitalization. RESULTS: Three female patients (mean age, 35 years) with CVC due to iatrogenic fungal meningitis were included. Positive Fungitell ß-D-glucan assay in cerebrospinal fluid was documented in all cases, and F. solani was confirmed by polymerase chain reaction in case 3. All cases were complicated by severe vertebrobasilar circulation vasculopathy and arterial dissections with resultant subarachnoid hemorrhage and intraventricular hemorrhage, ultimately leading to patients' death. CONCLUSIONS: The death toll from the ongoing fungal meningitis outbreak keeps rising, underscoring the need for early recognition and aggressive treatment. We highlight the risk for vertebrobasilar circulation CVC among these patients. The angioinvasive nature of F. solani is yet to be clarified; however, a clear pattern has been observed. Public health awareness should be raised and a strong response should be pursued.

Mental health help-seeking in Mexico.

Most people in need of mental health services in Mexico do not seek formal support or professional services to address their mental health needs. Understanding help-seeking behaviors is crucial to addressing underutilized mental health services and to leverage health promotion efforts. Data were collected as part of a larger research project on stigma and help-seeking for mental-health-related concerns in Mexico. A convenience sample of 469 adults residing in Mexico City participated in the study using an experimental vignette methodology assessing stigma toward individuals with mental health conditions, along with characteristics and demographic correlates of help-seeking. All survey measures were administered in Spanish. A structural regression was conducted for the outcome 'openness to professional help seeking for mental health problems' as a latent variable. Compared with males, females were more open to professional help seeking (b = 0.09, p = 0.038), as were people who endorsed higher spirituality (b = 0.01, p = 0.006); while people who experienced self-stigma were less open to professional help-seeking for mental health concerns (b = -0.15, p = 0.005). Self-stigma was a major driver of low service utilization. Contrary to previous studies, spirituality was a significant positive predictor of professional help-seeking. A more nuanced understanding of mental health help-seeking in Mexico can be useful for outreach efforts to increase service utilization both in Mexico and among Latinos in the United States (US). Given historical, geographic, and cultural ties with the US, it is important to understand mental health help-seeking in Mexico, which may relate directly to help-seeking behaviors in many US Latinos who have immigrated to the US. Directions for future research and practice implications are discussed, including a roadmap for health promotion activities.

Why Culture and Context Matters: Examining Differences in Mental Health Stigma and Social Distance Between Latino Individuals in the United States and Mexico.

This study examines the influence of cultural context on social distance and perceptions of stigma towards mental health conditions among Latino populations in Houston, TX, USA and Mexico City, Mexico. We employed a community-based experimental vignette survey to assess perceptions towards individuals experiencing symptoms of alcohol misuse, depression, and psychosis. Participants (n = 513) from Houston and Mexico City were asked about their willingness to accept community members experiencing mental health symptoms in various social roles, their perceptions of stigma related to these symptoms, anticipated danger, possible positive outcomes, and the community member's ability to change. Findings demonstrate significant differences in stigma perceptions between Latino respondents in the US and in Mexico. Houston participants reported lower public stigma and perceived dangerousness of someone with mental health concerns compared to respondents in Mexico City. Furthermore, the cultural context may influence the association between various dimensions of stigma, with some inverse relationships occurring based on location of data collection. Findings illuminate the complex interplay between cultural context, mental health symptoms, and stigma, and underscores the need for culturally nuanced interventions to reduce mental health stigma and promote service utilization in Latino communities.

Chemometric Evaluation of RI-Induced Phytochemicals in Phaseolus vulgaris Seeds Indicate an Improvement on Liver Enzymes in Obese Rats.

Liver enzymes alterations (activity or quantity increase) have been recognized as biomarkers of obesity-related abnormal liver function. The intake of healthy foods can improve the activity of enzymes like aspartate and alanine aminotransferases (AST, ALT), γ-glutaminyl transferase (GGT), and alkaline phosphatase (ALP). Beans have a high concentration of several phytochemicals; however, Restriction Irrigation (RI) during plant development amends their synthesis. Using chemometric tools, we evaluated the capacity of RI-induced phytochemicals to ameliorate the high activity of liver enzymes in obese rats. The rats were induced with a high-fat diet for 4 months, subsequently fed with 20% cooked beans from well-watered plants (100/100), or from plants subjected to RI at the vegetative or reproduction stage (50/100, 100/50), or during the whole cycle (50/50) for 3 months. A partial least square discriminant analysis indicated that mostly flavonols have a significant association with serum AST and ALT activity, while isoflavones lowered GGT and ALP. For AST and ALT activity in the liver, saponins remained significant for hepatocellular protection and flavonoids remained significant as hepatobiliary protectants by lowering GGT and ALP. A principal component analysis demonstrated that several flavonoids differentiated 100/50 treatment from the rest, while some saponins were correlated to 50/100 and 50/50 treatments. The intake of beans cultivated under RI improves obesity-impaired liver alterations.

Síndrome de dificultad respiratoria aguda por Mycobacterium tuberculosis de rápido crecimiento en una mujer con virus linfotrópico T humano tipo I-II / Acute respiratory distress syndrome due to rapidly growing Mycobacterium tuberculosis in a woman with human T-lymphotropic virus type I-II

La tuberculosis es una infección de distribución mundial con una alta morbimortalidad en países subdesarrollados. Presentamos el caso de una mujer de 55 años con cuadro de dos meses de adenomegalias cervicales, pérdida de peso y fiebre con posterior disnea de esfuerzo progresiva. Ingresó por urgencias en falla ventilatoria y hallazgos radiológicos compatibles con síndrome de dificultad respiratoria aguda (SDRA) requiriendo ventilación mecánica invasiva. Se demostró infección por M. tuberculosis por PCR en tiempo real GeneXpert MTB/RIF Ultra y en cultivo de medio líquido de esputo, con crecimiento en tiempo menor a tres días. La biopsia de las adenomegalias confirmó linfoma de células T periférico asociado a infección por virus linfotrópico T humano tipo I-II, presentando una evolución tórpida a pesar del esquema quimioterapéutico.

Tuberculosis is a globally distributed infection with high morbidity and mortality in underdeveloped countries. We present the case of a 55-year-old woman with a 2-month history of cervical lymph nodes, weight loss, and fever with subsequent progressive exertional dyspnea. She was admitted to the emergency department with ventilatory failure and radiological findings compatible with acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. M. tuberculosis infection was proved by a real-time PCR GeneXpert MTB/RIF Ultra and in culture of sputum liquid medium, with growth in less than 3 days. The biopsy of the lymph nodes revealed peripheral T-cell lymphoma associated with infection by human T-lymphotropic virus type I-II, presenting a torpid evolution despite the chemotherapy regimen.

Entangled States Induced by Electron-Phonon Interaction in Two-Dimensional Materials.

We report on the effects of electron-phonon interaction in materials such as graphene, showing that it enables the formation of a gap bridged by unique edge states. These states exhibit a distinctive locking among propagation direction, valley, and phonon mode, allowing for the generation of electron-phonon entangled states whose parts can be easily split. We discuss the effect of the chiral atomic motion in the zone boundary phonons leading to this effect. Our findings shed light on how to harness these unconventional states in quantum research.

Combining Ability and Reciprocal Effects for the Yield of Elite Blue Corn Lines from the Central Highlands of Mexico.

The development of hybrid plants can increase the production and quality of blue corn, and, thus, satisfy its high demand. For this development, it is essential to understand the heterotic relationships of the germplasm. The objectives of this study were to determine the effects of general (GCA) and specific (SCA) combining ability, as well as the reciprocal effects (REs) on the yields of 10 blue corn lines, and to select the outstanding lines. Diallel crosses were generated with 10 lines and evaluated at the Valle de México Experimental Station in Chapingo, Mexico, and Calpulalpan, Tlaxcala, Mexico. There were differences (p ≤ 0.01) in the hybrids, Loc, effects of GCA, SCA, and REs, and in the following interactions: hybrids × Loc, GCA × Loc, SCA × Loc, and RE × Loc. For GCA, lines Ll, L4, L6, and L9 stood out, with significant values of 3.4, 2.9, 2.9, and 3.1, respectively. For SCA, the hybrids featured were L4 × L10, L2 × L10, L1 × L10, L7 × L8, and L2 × L6, with values of 3.0, 2.5, 2.3, 2.3, and 2.2, and yields of 11.2, 10.2, 10.4, 10.4, and 10.5 t ha-l, respectively. There were no significant REs in these lines. Considerable effects of GCA and SCA were detected; therefore, we concluded that native populations had favorable dominance and additive genetic effects that could be used to support the development of high-yielding lines and hybrids.

Antifungal Activity of Rue Essential Oil and Commercial Chitosan on Native Corn Foliar Diseases.

Native corn in Cherán, Michoacán, southwestern Mexico, represents a high-impact economic, social, and religious support, although its yield is low due to fungal diseases. Fungicides are mainly used for their control, but the fungi involved create resistance. The aims of this study are to determine the incidence of foliar diseases in the field, isolate the causal fungi, evaluate the in vitro effect of the essential oil of rue (Ruta graveolens) on them, and identify the secondary metabolites. The essential oil was obtained using the steam distillation technique on fresh plants. Also used was an industrial-grade chitosan, and the commercial fungicide benomyl was used as a positive control. Rue essential oil was characterized by mass spectrometry with ultra-high-performance liquid chromatography with electrospray ionization (UHPLC-ESI). The highest incidence of disease was obtained for leaf rust (35%), followed by gray leaf spot (GLS) (24%) and leaf blight (19%). Rue essential oil inhibited 100% of the mycelial growth of Coniothyrium phyllachorae and 96% of the mycelium of Exseroilum turcicum. The benomyl fungicide effectively inhibited C. phyllachorae (86 to 91%), but not E. turcicum, with the opposite effect when using chitosan by inhibiting 89 to 90% of the latter's mycelial development. The majority compound of the essential oil of R. graveolens was 2-(3-phenylprop-2-enoyl)chromen-4-one; however, fatty acids were also detected: linoleic, palmitic, and retinoic acid.