Perioperative fluid status and surgical outcomes in patients undergoing cytoreductive surgery for advanced epithelial ovarian cancer.

OBJECTIVE: The objective of this study is to investigate the impact of fluid status on perioperative outcomes of patients undergoing cytoreductive surgery (CRS) for advanced epithelial ovarian cancer (EOC). METHODS: Patients undergoing CRS for stage III or IV EOC at a comprehensive cancer center from 12/2010 to 05/2015 were identified. Those who underwent upper abdominal procedures or colon resections were included. Demographic, perioperative, and 30-day complication data were collected. Perioperative weight change was utilized as a surrogate for fluid status. The time to diuresis (tD) was defined as the postoperative day the patient's weight began to downtrend. RESULTS: One hundred ten patients were included. Median age was 62years and median BMI 25.8kg/m2. The majority (74.5%) were stage IIIC. At least 1 bowel resection was performed in 60 cases (54.5%). A median of 5381mL of crystalloid (range 1000-17,550mL) and 500mL of colloids (range 0-2783mL) was given intraoperatively. The median perioperative weight change was +7.3kg (range-0.9kg to +35.7kg). The median tD was 3days (range 1-17days). On univariate analysis, net positive fluid status was associated with unscheduled reoperation, anastomotic leak, surgical site infections (SSI), and length of stay >5days. On multivariate analysis, fluid status was independently associated with SSI (p=0.01). CONCLUSIONS: Perioperative fluid excess is common in patients undergoing CRS for EOC and is independently associated with SSI.

Selective cardiac surveillance in patients with gynecologic cancer undergoing treatment with pegylated liposomal doxorubicin (PLD).

OBJECTIVE: The study objective was to examine the safety and cost savings of selective cardiac surveillance (CS) during treatment with pegylated liposomal doxorubicin (PLD). METHODS: A retrospective, dual institution study of women receiving PLD for the treatment of a gynecologic malignancy was performed. The study period was 2002-2014. At both institutions, a selective strategy for CS was implemented in which only high-risk women with a cardiac history or with symptoms suggestive of cardiac toxicity during PLD treatment underwent a cardiac evaluation. Patient demographics, clinical and treatment history were evaluated. Cost analyses were performed utilizing professional/technical fee rates for echocardiogram and multi-gated acquisition scan for each state. RESULTS: PLD was administered in 184 women. The mean patient age was 62.7years, and 79% were treated for recurrent ovarian or peritoneal carcinoma. The median cumulative administered dose of PLD was 300mg/m(2); 24 received >550mg/m(2). The median follow-up time was 20months. Of the 184 patients, the majority (n=157, 85.3%) did not undergo either an initial cardiac evaluation or surveillance during or post-PLD treatment. Fifty-three patients considered high risk for anthracycline-induced cardiotoxicity underwent CS. Only three patients (1.6%) in the entire cohort developed CHF that was possibly related to PLD treatment; all had significant pre-existing cardiac risk factors. Selective instead of routine use of CS in the study population resulted in a cost savings of $182,552.28. CONCLUSION: Utilizing cardiac surveillance in select women undergoing PLD treatment for gynecologic malignancies resulted in significant health care cost savings without adversely impacting clinical outcomes.

Prevalencia de tamizaje de Hepatitis y factores asociados para coinfección con otros marcadores infecciosos en banco de sangre durante 2006-2011 / Hepatitis Prevalence and Associated Factors for Coinfection with Other Infectious Markers in Blood Bank, 2006-2011 / Prevalência de Rastreio de Hepatite e Fatores Associados para Co-Infecção com Outros Marcadores Infecciosos em Banco de Sangue durante 2006-2011

Objetivo: establecer la prevalencia de Hepatitis B y C y factores asociados para coinfección con otros marcadores tamizados en banco de sangre en donantes voluntarios durante 2006-2011 en un banco de sangre de Colombia. Metodología: estudio de corte transversal retrospectivo analítico. La población de estudio estuvo conformada por 587.446 registros de donantes voluntarios de sangre, de los cuales 13.133 presentaron reactividad para Hepatitis B y/o Hepatitis C, se calculó odds ratio para establecer factores asociados con coinfección. Resultados: la media de edad fue de 38.55 ± 12.4. El (OR) para coinfección simultánea con otros marcadores de banco de sangre y las variables analizadas fueron: Hepatitis B en cuanto a régimen de afiliación 1.1 (1.04-1.36), género 1.4 (1.22-1.61), edad 4.2 (3.54-4.99); para Hepatitis C, edad 0.6 (0.38-1.00), y género 5.1 (3.07-8.78). Conclusiones: en este estudio se encontró que la edad es un factor de riesgo asociado para la reactividad simultánea con otros marcadores de tamizaje en banco de sangre. Se encontró un comportamiento diferente entre género según estudios reportados de coinfección.

Objective: To establish the prevalence of hepatitis B and C and factors related to coinfection with other markers screened in blood bank volunteer donors between 2006 and 2011 in a blood bank in Colombia. Methods: Retrospective cross-sectional study. The study population consisted of 587.446 records of volunteer blood donors, of which 13.133 showed reactivity to hepatitis B and/or hepatitis C; odds ratios were calculated to establish factors associated with coinfection. Results: The mean age was 38.55 ± 12.4. The odds ratios for simultaneous coinfection with other blood bank markers and analyzed variables were membership scheme 1.1 (1.04 to 1.36), gender 1,4 (1.22 ­ 1.61), and age 4.2 (3.54 to 4.99) for hepatitis B, and age 0.6 (0.38-1.00) and gender 5.1 (3.07-8.78) for hepatitis C. Conclusions: This study demonstrates that age is a risk factor for simultaneous reactivity with other screening markers in blood banks. A different behavior was found between gender according to existing coinfection studies.

Objetivo: Estabelecer a prevalência de Hepatite B e C e fatores associados para co-infecção com outros marcadores rastreados em Banco de Sangue em doadores voluntários durante 2006-2011 num banco de sangue de Colômbia. Metodologia: Estudo de corte transversal retrospectivo inferencial, de tipo relacional. A população de estudo esteve conformada por 587446 registos de doadores voluntários de sangue dos quais 13133 apresentaram reatividade para Hepatites B e/ou Hepatite C, calculou-se Odds Ratio para estabelecer fatores associados a co-infecção. Resultados: A média de idade foi de 38.55 ± 12.4. O (OR) para co-infecção simultânea com outros marcadores de banco de sangue e as variáveis analisadas foi: Hepatite B quanto a regime de afiliação 1.1 (1.04-1.36), gênero 1.4 (1.22-1.61), idade 4.2 (3.54-4.99); para hepatite C idade e gênero 0.6 (0.38-1.00) 5.1 (3.07-8.78). Conclusões: Neste estudo se encontrou que a idade é um fator de risco associado para a reatividade simultânea com outros marcadores de rastreio em banco de sangue, encontrou-se um comportamento diferente entre gênero segundo estudos reportados de co-infecção.

Reproducibilidad interevaluador del Formato de ObservaciónSistemática de la Alineación Corporal en estudiantes universitarios / Inter-rater reliability of the Body Alignment Systematic Observation Form in college students

Objetivo: Estimar la reproducibilidad interevaluador del Formato de Observación Sistemáticade la Alineación Corporal (FOSAC), aplicado a adultos jóvenes de una universidad privada deBucaramanga (Colombia).Metodología: Se realizó un estudio de pruebas diagnósticas en una muestra de 123 estudiantesuniversitarios de 18 a 29 a˜nos de edad, que cumplieran con los criterios de inclusión establecidos.Tres examinadores (un experto en postura, una fisioterapeuta con experiencia y unaestudiante de último semestre de fisioterapia) realizaron el examen postural, analizando 7 fotografíasimpresas: una posterior, 2 laterales derechas, 2 laterales izquierdas y 2 anteriores. Seexaminaron 63 deficiencias que fueron registradas en el FOSAC.Resultados: La reproducibilidad interevaluador para determinar deficiencias posturales oscilóentre pobre y aceptable. Los planos que obtuvieron mejor reproducibilidad de acuerdo alíndice kappa global fueron el lateral izquierdo y derecho, en los cuales el 35,7% de las deficienciasobtuvo un kappa por encima de 0,40. Escoliosis en S fue la deficiencia con mayorreproducibilidad en el ítem experto vs. estudiante en el plano posterior, con un valor kappa de1,00.Conclusiones: La baja reproducibilidad interevaluador conduce a considerar que la exploraciónpostural por observación directa no es el método adecuado para usar en investigaciones. Sinembargo, permite al profesional detectar deficiencias posturales marcadas; por esta razón,no debería ser excluida del proceso de evaluación fisioterapéutica. Por otra parte, el FOSACpuede constituirse en una herramienta útil en la formación académica del futuro profesional enfisioterapia, al establecer metódicamente el proceso de observación de la alineación corporal (AU)

Objective: To estimate the inter-rater reliability of the Body Alignment Systematic ObservationForm (BASOF) applied to young adults in a private university in Bucaramanga (Colombia).Methodology: A study of diagnostic tests was performed in a sample of 123 college students,aged 18 to 29, who met the inclusion criteria. Three examiners (an expert in posture, a physiotherapistwith experience and a last semester student of physiotherapy) performed the posturalexamination, analyzing 7 printed photographs: one posterior, two right laterals, two left lateralsand two anterior. We studied 63 deficiencies, which were registered in the BASOF.Results: The inter-rater reliability to determine postural deficiencies ranged from poor toacceptable. The level obtaining the best reliability according to the global Kappa index wasthe posterior one in which 26.5% of the deficiencies obtained a kappa Index greater than0.40. The scoliosis in S variable had the highest reliability with a kappa value of 1.00, obtainedon the item expert vs student on the posterior plane.Conclusions: The low inter-rater reliability leads to the conclusion that postural examination bydirect observation method is not suitable for use in research. However, it allows the practitionerto detect marked postural deficiencies and therefore should not be excluded from the physiotherapyexamination. Moreover, the BASOF can become a useful tool in the future academiccareer in physical therapy to establish methodically the process of observing body alignment (AU)