Features and outcomes of rectal cancer patients treated in a hospital in Bogotá, Colombia: a retrospective cohort study.

Rectal cancer is an increasing disease worldwide. The outcomes of its treatment are related to the preoperative characteristics of the patient. The objective of this study was to describe sociodemographic, clinical and surgical characteristics and outcomes of patients operated on for rectal cancer at Hospital Universitario Mayor Méderi (HUM) during the period within 2013-2017.A retrospective descriptive cohort-type study was carried out by consulting the clinical records of patients above the age of 18 years with a clinical/histopathological diagnosis of rectal cancer and an institutional follow-up in those who underwent surgery with laparoscopic anterior resection of the rectum carried out by the coloproctology service of the HUM between 2013 and 2017. For statistical analysis, the SPSS V22 program was used.Data from 133 patients were collected during the study period, most of them male, with more frequent involvement of the lower rectum. Complications occurred in 25% of the patients. Conversion rate to open surgery was 8.6%, in-hospital death was associated with cardiovascular comorbidity, corticosteroid uses and with the presence of complications. Sociodemographic characteristics of the patients were similar to the world population. The institution has a low prevalence of anastomotic dehiscence, global complications are comparable with international statistics.

Absceso hepático por Enterobius vermicularis como diagnóstico diferencial de metástasis hepática en cáncer colorrectal, reporte de caso / Liver Abscess Caused by Enterobius vermicularis as a Differential Diagnosis for Liver Metastasis in Colorectal Cancer, Case Report

Resumen Introducción: el cáncer colorrectal es la cuarta causa de mortalidad asociada con cáncer en el mundo. La identificación de las metástasis de este tumor en el momento prequirúrgico es cada vez más frecuente por los estudios imagenológicos con los que se cuenta en la actualidad. Presentamos el caso de una paciente con infección por Enterobius vermicularis que simula la presencia de metástasis hepáticas. Presentación del caso: se presenta el caso de una paciente femenina proveniente del área rural, con dolor abdominal de 1 año de evolución asociado con hemorragia de vías digestivas bajas y pérdida de peso. Las imágenes y estudios endoscópicos muestran una lesión tumoral en el colon sigmoide con biopsias que reportan adenocarcinoma de colon sigmoides, además de lesiones hepáticas sugestivas de malignidad. Se llevó a resección anterior de recto y sigmoides con anastomosis alta y toma de biopsias hepáticas, que descartaron la malignidad e informaron la presencia de infección hepática por E. vermicularis. Discusión: La infección por E. vermicularis a nivel hepático presentada en el caso es poco frecuente, dicha infección puede simular la presencia de metástasis hepáticas, por lo cual debe tenerse en cuenta como diagnóstico diferencial de enfermedad metastásica de cáncer colorrectal.

Abstract Introduction: colorectal cancer is the fourth leading cause of cancer-related mortality worldwide. The identification of the metastases of this tumor in the preoperative stage is increasingly frequent due to the imaging studies currently available. We present the case of a patient with an infection caused by Enterobius vermicularis that simulates the presence of liver metastases. Case presentation: a female patient from a rural area showing a one-year abdominal pain evolution associated with lower gastrointestinal tract bleeding and weight loss. Endoscopic imaging and studies displayed a tumor lesion in the sigmoid colon, with biopsies reporting sigmoid colon adenocarcinoma and liver lesions suggesting malignancy. Anterior resection of the rectum and sigmoid was performed with high anastomosis and liver biopsies, which ruled out malignancy and reported the presence of liver infection by E. vermicularis. Discussion: in this case, the hepatic E. vermicularis infection was rare. This infection can simulate the presence of liver metastases; therefore, it should be considered a differential diagnosis of metastatic colorectal cancer.

Anal canal lymphoma: Case report and literature review / Linfoma de canal anal, reporte de caso y revisión de la literatura

Abstract Introduction: Primary tumors of the anal canal other than carcinomas are rare entities; among them, anal canal lymphomas are extremely unusual and pose both a diagnostic and therapeutic challenge for the coloproctologist. Case presentation: A male patient with positive human immunodeficiency virus (HIV) with proctalgia and mass sensation at the perianal level. A concentric thickening of the walls of the lower rectum was documented by magnetic resonance imaging, with colonoscopy and biopsies with histopathology compatible with plasmablastic lymphoma. Therefore, a diverting colostomy was performed and, subsequently, the hematology service indicated chemotherapy with the EPOCH scheme. Discussion: Lymphoma of the anus represents 0.2 % of anorectal tumors, most of these are non-Hodgkin's lymphomas; Hodgkin's disease at the anorectal level is even rarer. The population with the highest risk of this entity is HIV-positive patients, such as the patient in this case, although other associated factors are described in the literature.

Resumen Introducción: los tumores primarios del canal anal diferentes a carcinomas son entidades poco frecuentes; dentro de estos, los linfomas del canal anal son extremadamente raros y generan un reto tanto diagnóstico como terapéutico para el coloproctólogo. Presentación de caso: se presenta a continuación un caso clínico de un paciente con virus de inmunodeficiencia humana (VIH) positivo con proctalgia y sensación de masa a nivel perianal, se documentó por resonancia magnética un engrosamiento concéntrico de las paredes del recto inferior, con realización de colonoscopia y biopsias con histopatología compatible con linfoma plasmablástico, por lo que se realizó una colostomía derivativa y, posteriormente, se indicó por el servicio de hematología una quimioterapia con esquema EPOCH. Discusión: el linfoma de ano representa el 0,2 % de los tumores anorrectales, la mayoría de estos corresponde a linfomas no Hodgkin, y es aún más rara la enfermedad de Hodgkin a nivel anorrectal. La población con mayor riesgo de presentar esta entidad es los pacientes con VIH positivo, como el paciente descrito en el caso, aunque existen otros factores asociados descritos en la literatura.

Rapid and improved identification of drinking water bacteria using the Drinking Water Library, a dedicated MALDI-TOF MS database.

According to the European Directives (UE) 2020/2184 and 2009/54/EC, which establishes the sanitary criteria for water intended for human consumption in Europe, water suitable for human consumption must be free of the bacterial indicators Escherichia coli, Clostridium perfringens and Enterococcus spp. Drinking water is also monitored for heterotrophic bacteria, which are not a human health risk, but can serve as an index of bacteriological water quality. Therefore, a rapid, accurate, and cost-effective method for the identification of these colonies would improve our understanding of the culturable bacteria of drinking water and facilitate the task of water management by treatment facilities. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is potentially such a method, although most of the currently available mass spectral libraries have been developed in a clinical setting and have limited environmental applicability. In this work, a MALDI-TOF MS drinking water library (DWL) was defined and developed by targeting bacteria present in water intended for human consumption. This database, made up of 319 different bacterial strains, can contribute to the routine microbiological control of either treated drinking water or mineral bottled water carried out by water treatment and distribution operators, offering a faster identification rate compared to a clinical sample-based library. The DWL, made up of 96 bacterial genera, 44 of which are not represented in the MALDI-TOF MS bacterial Bruker Daltonics (BDAL) database, was found to significantly improve the identification of bacteria present in drinking water.

Chemometric analysis for river water quality assessment at the intake of drinking water treatment plants.

Most of the Mediterranean rivers are suffering the effects of industrial, urban and mining discharges, as well as a reduction in water quantity and quality. Additionally, due to the Mediterranean climate, the natural water resource availability is periodically lower than the water demand in the area. Operation of drinking water plants in these geographical areas needs advanced process control systems where real-time and in-line water quality monitoring tools are key components. Data sets with parameters generated by monitoring sensors and from laboratory analysis are used to reveal the main factors that characterize water quality. Chemometric tools like Principal Component Analysis (PCA) can be used to explore and analyze correlations among different physicochemical and microbiological parameters with the aim to assess the river water quality at the water intake of drinking water treatment plants (DWTPs). Strong seasonal trends in the organic and inorganic matter contents and unusual events in the raw river water quality at the DWTP water intake are revealed. Organic and inorganic patterns are then associated with climatological, meteorological and industrial pollution circumstances typical for the geographical region under study. In addition, microbiological events can be detected at the water intake of DWTP which may occur simultaneously with increasing water contents of organic matter, especially at the beginning of rainfall episodes. The application of PCA on sensors data in the water intake at DWTPs offers new possibilities for improved quality assurance and control procedures for DWTP management and its strategy.

Acceptability of Dry Dog Food Visual Characteristics by Consumer Segments Based on Overall Liking: a Case Study in Poland.

Sensory analysis of pet foods has been emerging as an important field of study for the pet food industry over the last few decades. Few studies have been conducted on understanding the pet owners’ perception of pet foods. The objective of this study is to gain a deeper understanding on the perception of the visual characteristics of dry dog foods by dog owners in different consumer segments. A total of 120 consumers evaluated the appearance of 30 dry dog food samples with varying visual characteristics. The consumers rated the acceptance of the samples and associated each one with a list of positive and negative beliefs. Cluster Analysis, ANOVA and Correspondence Analysis were used to analyze the consumer responses. The acceptability of the appearance of dry dog foods was affected by the number of different kibbles present, color(s), shape(s), and size(s) of the kibbles in the product. Three consumer clusters were identified. Consumers rated highest single-kibble samples of medium sizes, traditional shapes, and brown colors. Participants disliked extra-small or extra-large kibble sizes, shapes with high-dimensional contrast, and kibbles of light brown color. These findings can help dry dog food manufacturers to meet consumers’ needs with increasing benefits to the pet food and commodity industries.

Factores preoperatorios de riesgo asociados a conversión a técnica abierta en colecistectomía laparoscópica de urgencia / Preoperative risk factors associated with conversion to open technique in emergency laparoscopic cholecystectomy

Introducción. La colecistectomía laparoscópica es la técnica de elección en pacientes con indicación de extracción quirúrgica de la vesícula; sin embargo, en promedio, el 20 % de estos requieren conversión a técnica abierta. En este estudio se evaluaron los factores preoperatorios de riesgo para conversión en colecistectomía laparoscópica de urgencia. Metodología. Se llevó un estudio de casos y controles no pareado. Se obtuvo información sociodemográfica y de las variables de interés de los registros de las historias clínicas de los pacientes operados entre el 2013 y el 2016. Se identificaron los motivos de conversión de la técnica quirúrgica. Se caracterizó la población de estudio y se estimaron las asociaciones según la naturaleza de las variables. Mediante un análisis de regresión logística se ajustaron las posibles variables de confusión. Resultados. Se analizaron los datos de 444 pacientes (111 casos y 333 controles). La causa de conversión más frecuente fue la dificultad técnica (50,5 %). Se encontró que la mayor edad, el sexo masculino, el antecedente de cirugía abierta en hemiabdomen superior, el signo clínico de Murphy positivo, la dilatación de la vía biliar, la leucocitosis y la mayor experiencia del cirujano fueron los factores de riesgo para la conversión. Se encontró un área bajo la curva ROC de 0,743 (IC95% 0,692-0,794, p≤0,001). Discusión. Existen factores que se asocian a mayor riesgo de conversión en colecistectomía laparoscópica. La mayoría se relaciona con un proceso inflamatorio avanzado, por lo que la intervención temprana y oportuna debe ser el estándar de manejo en el abordaje de pacientes con patología quirúrgica de la vesícula

Introduction: Laparoscopic cholecystectomy is the preferred technique for patients with indication for gallbladder extraction. Nevertheless, up to near 20% of them require conversion to open surgery. In this study we evaluated preoperative risk factors for conversion in patients undergoing emergency laparoscopic cholecystectomy. Methodology: a case-control unmatched study was conducted. Sociodemographic Information and other variables were obtained from the medical records of patients that underwent surgery in the period 2013 to 2016. Reasons for conversion were identified and the study population was characterized. Correlations tests were established and logistic regression was performed for evaluating the role of confounding factors. Results: we analyzed the medical records of 444 patients (111 cases and 333 controls). The most common reasons for conversion were technical difficulty (50,5%), older age, male sex, previous open upper abdominal surgery, Murphy´s sign, bile duct dilation, total white cell count >12.000/mm3 , and a more experienced surgeon. Area under COR was 0.743 (CI95% 0.692­0.794, p= <0.001). Discussion: some factors increase the risk for conversion to open surgery in laparoscopic cholecystectomy. Most of them are related to an advanced gallbladder inflammatory process, thus early and timely intervention should be the gold standard in the management of patients with surgical gallbladder pathology

Reducción de la infección perineal tras la resección abdomino-perineal por cáncer de recto mediante la malla de colágeno impregnada con gentamicina / Reduction of perineal infection following abdominoperineal resection with the use of gentamicin-collagen fleece

Introducción. La resección abdomino-perineal en pacientes con cáncer de recto sometidos a radioterapia preoperatoria tiene como complicación frecuente la infección perineal del sitio operatorio, que se manifiesta desde celulitis hasta colecciones perineales y dehiscencia de la herida lo que aumenta de manera significativa el tiempo de la hospitalizacion. El reducir la incidencia de la infección del sitio operatorio contribuye a disminuir la morbimortalidad perioperatoria. El uso local de antibióticos en la herida quirúrgica se ha reportado en la literatura como un factor protector con resultados promisorios para evitar esta complicación. Métodos. Se presenta una serie de casos en la que se analizan los resultados de 12 pacientes con diagnóstico de cáncer de recto, sometidos a resección abdomino-perineal más colocación de malla de colágeno impregnada con gentamicina en el cierre perineal. El estudio incluyó pacientes atendidos en el Servicio de Coloproctología del Hospital Universitario San Ignacio. Su principal objetivo fue describir la experiencia institucional con este tipo de mallas como medida preventiva para disminuir la infección perineal en estos pacientes. Resultados. La incidencia de infección fue de 41 % con la utilización de la malla de gentamicina. Nueve de los 12 pacientes habían recibido neoadyuvancia con quimiorradioterapia y tres fueron intervenidos quirúrgicamente sin neoadyuvancia previa por presentar tumores T1 /T2 . Se presentó infección del sitio operatorio en cinco pacientes, en tres fue de tipo superficial y, en dos, de órgano y espacio y requirió manejo quirúrgico. No se demostraron efectos secundarios de la malla con gentamicina. Conclusiones. Los resultados muestran una tendencia positiva de la efectividad de las mallas con gentamicina para disminuir la aparición de infección del sitio operatorio. En comparación con los pacientes intervenidos sin neoadyuvancia, los que reciben neoadyuvancia tienen mayor riesgo de infección del sitio operatorio. La implementación de las mallas con gentamicina no supone una modificación mayor de la técnica quirúrgica ni aumenta la morbilidad del procedimiento. Si bien estas observaciones son indicios de que el uso de mallas con antibiótico tópico tiene un impacto positivo en la reducción de infección del sitio operatorio, se requieren estudios futuros para obtener resultados estadísticamente significativos

Background: Abdominal-perineal resection in patients with rectal cancer undergoing preoperative radiotherapy exhibit as a frequent complication the perineal infection of the operative site, manifested as cellulitis to perineal collections and wound dehiscence, which significantly increases hospitalization time. Reducing the incidence of operative site infection helps to diminish perioperative morbidity and mortality. The use of local antibiotics in the surgical wound has been reported in the literature as a protective factor with promising results to avoid this complication Methods: This is a case series report to study the outcome of patients undergoing abdominoperineal resection with the implantation of a gentamicin-collagen fleece in the perineal closure. Patients included were treated by the Department of Coloproctology of the Hospital Universitario San Ignacio (HUSI), Bogotá, Colombia. The main purpose of the study was to describe the institutional experience with the utilization of the gentamicin-collagen fleece to reduce the risk of surgical site infection. Results: Twelve patients were included. Surgical site infection incidence was 41% when the gentamicin-collagen fleece was used. Nine patients had received neoadyuvant therapy and three were taken to surgery without previous neoadyuvant therapy. Five patients developed surgical site infection, superficial surgical site infection was present in three and organ/space surgical site infection developed in two cases requiring surgical drainage. There was no evidence of adverse reactions with the use of the gentamicin-collagen fleece. Conclusions: The results show a positive effect of the gentamicin-collagen fleece in reducing the frequency of surgical site infection. Patients who received neoadyuvant therapy had a higher risk of surgical site infection. There is no need to modify the surgical technique and there is no increase in the procedures' morbidity with the use of the gentamicin-collagen fleece. Even though the results indicate a possible reduction in the surgical site infection incidence, further studies are required to obtain statistically significant conclusions

Cáncer colorrectal hereditario no asociado a poliposis o síndrome de Lynch / Hereditary colorectal cancer not associated with polyposis or Lynch syndrome

El cáncer colorrectal hereditario no asociado a poliposis, también llamado síndrome de Lynch, es reconocido como un síndrome hereditario de patrón autosómico dominante de penetrancia incompleta, en el cual hay mutación en los genes reparadores del ADN. De 2 a 3 % de todos los tumores colorrectales se originan por este síndrome hereditario que predispone a su desarrollo. El síndrome Lynch, el más frecuente de los síndromes genéticos, incrementa, además del riesgo de desarrollar cáncer de colon, el de cáncer metacrónico y otros tipos de cáncer no colorrectal como los de endometrio, de intestino delgado, de uréter o de la pelvis renal. Por lo tanto, es indispensable reconocerlo e identificar a los individuos en riesgo de presentarlo para prevenir, diagnosticar y tratar de manera precoz la aparición de estas neoplasias, y poder disminuir las tasas de morbilidad y mortalidad asociadas

Hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome is recognized as an autosomal dominant hereditary syndrome of incomplete penetrance characterized by mutations in DNA repair genes. It is the most frequent of all the hereditary syndromes, and increases the likelihood of developing colorectal cancer, thus representing 2-3% of all colorectal cancers (CRC). This syndrome predisposes to metachronous (CRC) and other extracolonic cancers, as endometrium, small bowel, ureter and renal pelvis, among others. Therefore, it is necessary to recognize this syndrome and identify individuals with HNPCRC to prevent, diagnose and provide, if possible, early treatment in an effort to decrease its morbidity and mortality

Thermal desorption gas chromatography with mass spectrometry study of outgassing from polymethacrylimide foam (Rohacell®).

Polymethacrylimide foams are used as light structural materials in outer-space devices; however, the foam closed cells contain volatile compounds that are outgassed even at low temperatures. These compounds ignite as plasmas under outer-space radiation and the intense radio-frequency fields used in communications. Since plasmas may cause spacecraft fatal events, the conditions in which they are ignited should be investigated. Therefore, qualitative and quantitative knowledge about polymethacrylimide foam outgassing should be established. Using thermogravimetric analysis, weight losses reached 3% at ca. 200°C. Thermal desorption gas chromatography with mass spectrometry detection was used to study the offgassed compounds. Using successive 4 min heating cycles at 125°C, each one corresponding to an injection, significant amounts of nitrogen (25.3%), water (2.6%), isobutylene (11.3%), tert-butanol (2.9%), 1-propanol (11.9%), hexane (25.3%), propyl methacrylate (1.4%), higher hydrocarbons (11.3%), fatty acids (2.2%) and their esters (1.3%), and other compounds were outgassed. Other compounds were observed during the main stage of thermal destruction (220-280°C). A similar study at 175°C revealed the extreme difficulty in fully outgassing polar compounds from polymethacrylimide foams by baking and showed the different compositions of the offgassed atmosphere that can be expected in the long term.