[Impact of attend to day care associated with healthy weight in infants and preschoolers]. / Impacto del cuidado infantil en guarderías asociado con peso saludable en lactantes y preescolares.

Background: Being overweight affects millions of infants and preschoolers in the world, affecting their quality and life expectancy. Exposure to day care centers may play an important role in preventing unhealthy weight (UW). Objective: To point out the prevalence and association of day care exposure and other factors associated with UW in infants and preschoolers. Methods: An analytical cross-sectional study was carried out. Infant population aged 6-47 months without comorbidities that compromised their nutritional status were included, and those with formal childcare different from the selected day care were excluded. Exposure to day care, and other factors (perinatal, physical activity, nutritional, and familiar) were evaluated. A z score > 1 SD was considered UW. Prevalence, odds ratios (OR), 95% confidence intervals (95%CI) and adjusted RM by low birth weight, initiation of complementary feeding, consumption of sugary drinks, daytime naps, maternal nutritional status, and family income quintile through logistic regression. Results: The overall prevalence of UW was 17.84% (95%CI: 14.93-21.16), 11.84 (95%CI: 8.54-16.14) for children exposed to day care, and 23.78% (95%CI: 19.21-29.02) in unexposed infant population, showing significant differences between both prevalences (p < 0.001). The adjusted OR for UW presentation was 0.39 (95% CI: 0.23-0.66). Conclusions: Exposure to IMSS day care has shown to be a possible protective environment against the development of a UW.

Introducción: el sobrepeso afecta a millones de lactantes y preescolares en el mundo afectando su calidad y esperanza de vida. La exposición a guarderías puede jugar un papel importante para prevenir un peso no saludable (PNS). Objetivo: indicar la prevalencia y la asociación de la exposición a guarderías y otros factores asociados con el PNS en lactantes y preescolares. Métodos: se realizó un estudio transversal analítico. Se incluyó población infantil de 6-47 meses sin comorbilidades que comprometieran su estado nutricional y se excluyeron a aquellos con un cuidado infantil formal diferente al de las guarderías seleccionadas. Se evaluó la exposición a guardería, y otros factores (perinatales, actividad física, nutricionales, y familiares). Se consideró PNS una puntuación z > 1 DE. Se obtuvieron prevalencias, razones de momios (RM), intervalos de confianza del 95% (IC95%) y RM ajustadas por edad, bajo peso al nacer, inicio de la alimentación complementaria, consumo de bebidas azucaradas, siestas diurnas, estado nutricional materno y quintil de ingreso familiar a través de regresión logística. Resultados: la prevalencia general de PNS fue de 17.84% (IC95%:14.93-21.16), 11.84 (IC95%: 8.54-16.14) para la población infantil expuesta a guarderías, y 23.78% (IC95%: 19.21-29.02) en no expuestos, mostrando diferencias significativas entre ambas prevalencias (p < 0.001). La RM ajustada para la presentación de PNS fue de 0.39 (IC95%: 0.23-0.66) para exposición a guardería. Conclusiones: la exposición a guarderías IMSS mostró ser un posible ambiente protector contra el desarrollo de un PNS.

Transgastric laparoscopic polypectomy in giant gastric polyps not susceptible of endoscopic management: novel surgical technique and case series.

BACKGROUND: The identification of gastric polyps incidentally in endoscopies of the upper digestive tract has increased its incidence, varying between 0.5% and 23%. 10% of these polyps have symptoms, 40% are hyperplastic. We allow ourselves to propose a laparoscopic technique for the management of giant hyperplastic polyps associated with a pyloric syndrome, not susceptible to endoscopic resection. METHOD: A series of patients approached by laparoscopic transgastric polypectomy due to the giant gastric polyps associated with pyloric syndrome, in Bogotá, Colombia, from January 2015 to December 2018. RESULTS: Seven patients, 85% female, with an average age of 51 years, who were admitted for pyloric syndrome and were taken to laparoscopic management, with an average surgical time of 42 min, intraoperative bleeding 7-8 cc, tolerance to the oral route 24 hours, no conversion, without mortality. CONCLUSIONS: Transgastric polypectomy for the management of benign giant gastric polyps that cannot be resected endoscopically turns out to be a feasible method, with a low rate of complications and without mortality.

ANTECEDENTES: La identificación de pólipos gástricos de manera incidental en endoscopias de vías digestivas altas ha aumentado su incidencia, que varía entre el 0.5% y el 23%. El 10% de estos pólipos presentan síntomas y el 40% son hiperplásicos. Nos permitimos proponer una técnica laparoscópica para el manejo de los pólipos hiperplásicos gigantes asociados a síndrome pilórico no susceptibles de resección endoscópica. MÉTODO: Serie de pacientes llevados a polipectomía transgástrica laparoscópica por hallazgo de pólipos gástricos gigantes asociados a síndrome pilórico, en Bogotá, Colombia, de enero de 2015 a diciembre de 2018. RESULTADOS: Un total de siete pacientes, el 85% de sexo femenino, con edad promedio de 51 años, ingresaron por síndrome pilórico y fueron llevados a manejo laparoscópico, con un tiempo quirúrgico promedio de 42 minutos, sangrado intraoperatorio de 7-8 cc, tolerancia a la vía oral a las 24 horas, no conversión, sin mortalidad. CONCLUSIONES: La polipectomía transgástrica para el manejo de pólipos gástricos gigantes benignos que no pueden ser resecados por vía endoscópica resulta ser un método factible, con una baja tasa de complicaciones y sin mortalidad.

Impacto clínico en el hombro del enclavijamiento endomedular anterógrado en el tratamiento de fracturas de la diáfisis humeral / Clinical impact on the shoulder after antegrade intramedullary nailing in humeral shaft fractures

Introducción: el enclavijamiento endomedular (EE) es una opción terapéutica para fracturas de la diáfisis humeral; sin embargo, algunos pacientes tratados con EE desarrollan signos de pinzamiento subacromial y disminución de la fuerza en movimientos de flexión y abducción.Objetivo: evaluar el impacto en el hombro del uso del EE anterógrado para el tratamiento de fracturas de la diáfisis humeral en términos de dolor, funcionalidad y signos de pinzamiento subacromial.Metodología: estudio observacional retrospectivo realizado en 25 pacientes adultos con fracturas de la diáfisis humeral tratadas con EE anterógrado. Se realizó seguimiento entre 6 y 12 meses después del procedimiento, valorando la funcionalidad (arcos de movimiento y escala QuickDASH) y la presencia de dolor (escala visual análoga [EVA]) y signos de pinzamiento subacromial (según Yocum, Neer y Hawkins-Kennedy). Los datos se describen utilizando frecuencias absolutas y relativas para las variables cualitativas, y medias y desviaciones estándar para las cuantitativas.Resultados: las medias de la flexión anterior, puntaje en la escala QuickDASH y escala EVA fueron 145° (±31,6), 6,1 (±8,5) y 2,32 (±2,06), respectivamente. El 32% de los pacientes presentó uno o más signos de pinzamiento subacromial. Además, la consolidación completa de la fractura ocurrió en todos los casos.Conclusiones: dado que no se evidenció un impacto significativo en el hombro en términos de movilidad, dolor o signos de pinzamiento subacromial y que la consolidación de la fractura ocurrió en todos los casos, el EE fue adecuado para el tratamiento de fracturas de la diáfisis humeral

Introduction: Intramedullary nailing (IN) is a common therapeutic option for humeral shaft fractures. However, some patients treated with IN develop signs of subacromial impingement and decreased strength in flexion and abduction movements. Objective: To evaluate the clinical impact of the use of antegrade IN on the shoulder for the treatment of humeral shaft fractures in terms of pain, functionality, and subacromial impingement symptoms.Methodology: Retrospective observational study carried out in 25 adult patients with humeral shaft fractures treated with antegrade IN. Follow-up was performed 6 to 12 months after the procedure, assessing functionality (arcs of motion and QuickDASH scale), as well as the presence of pain (visual analog scale [VAS]) and signs of subacromial impingement (according to Yocum, Neer and Hawkins-Kennedy). Data are described using absolute and relative frequencies for qualitative variables and means and standard deviations for quantitative variables.Results: The mean anterior flexion, QuickDASH score, and VAS score were 145° (±31.6), 6.1 (±8.5), and 2.32 (±2.06), respectively. One or more signs of subacromial impingement were observed in 32% of the patients. In addition, complete fracture healing occurred in all cases.Conclusion: Given that no significant impact on the shoulder was evidenced in terms of mobility, pain or signs of subacromial impingement and that fracture healing occurred in all cases, IN was adequate for the treatment of humeral shaft fractures.

Laparoendoscopic surgery for the treatment of gastrointestinal stromal tumors: A case series.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The standard management for localized GIST is the complete surgical resection. For this procedure, laparoendoscopic cooperative surgery (LECS) has been proposed as a safe and effective alternative. We want to show our experience with LECS technique for the management of GIST and a literature review. MATERIALS AND METHODS: A retrospective, cross-sectional study was carried out, which included patients with a diagnosis of localized GIST treated with LECS technique between January 2011 and December 2018. RESULTS: During the period of the study, 21 patients were managed by LECS technique, with a male-female rate 3:1. Average surgical time was 98.5 min, 100% negative borders in all patients. Intraoperative bleeding was 30.7 cc and all patients had orally tolerance in the first 24 h. None of them required ICU management, no mortality was reported. CONCLUSIONS: The LECS technique has demonstrated to be a viable, safe, and effective technique for the management of gastric GIST's, showing superiority in organ function preservation and in the range of oncological margins. Prospective studies are necessary to obtain knowledge about the outcome of patients managed through LECS technique.

INTRODUCCIÓN: Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquimales más comunes del tracto gastrointestinal. El tratamiento estándar para los GIST localizados es la resección quirúrgica completa. Para este procedimiento, el abordaje cooperativo laparo-endocopico (ACLE) se ha propuesto como una alternativa segura y eficaz. Queremos mostrar nuestra experiencia con la técnica ACLE para el manejo de GIST y unzaa revisión de la literatura. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, transversal, que incluyó pacientes con diagnóstico de GIST localizado tratados con la técnica ACLE entre enero de 2011 y diciembre de 2018. RESULTADOS: Durante el periodo de estudio se manejaron 21 pacientes con técnica de ACLE, con una tasa hombre-mujer de 3:1. El tiempo quirúrgico promedio fue de 98.5 min, con 100% de bordes negativos en todos los pacientes. El sangrado intraoperatorio fue de 30.7 cc y todos los pacientes tuvieron tolerancia oral en las primeras 24H. Ninguno de ellos requirió manejo en UCI, no se reportó mortalidad. CONCLUSIONES: La técnica ACLE ha demostrado ser una técnica viable, segura y eficaz para el manejo de los GIST gástricos. Mostrando superioridad en la preservación de la función orgánica y en los magines oncológicos. Son necesarios estudios prospectivos para conocer el resultado de los pacientes manejados mediante la técnica ACLE.

Telerehabilitación para el tratamiento de retracción capsular posterior del hombro con tendinopatía secundaria del manguito rotador / Telerehabilitation for the treatment of posterior capsular retraction of the shoulder with secondary rotator cuff tendinopathy

Introducción. El acceso a los servicios de rehabilitación para tratarsíntomas dolorosos del hombro puede verse limitado por dificultades multifactoriales del sistema de salud, pero ademásrecientemente se ha visto restringido por las medidas de distanciamiento social implementadas para prevenir la propagación de la COVID-19. Objetivo. describir el efecto de un plan de tratamiento teledirigido de rehabilitación para tratarla retracción de la cápsula posterior del hombro con tendinopatía secundaria del tendón del músculo supraespinoso del manguito rotador. Métodos. Estudio descriptivo observacional prospectivo realizado en 15 pacientes con retracción de la cápsula posterior del hombro con tendinopatía secundaria del tendón del músculo supraespinoso del manguito rotador tratados con telerehabilitación durante cinco semanas. Se evaluó la funcionalidad, el dolor y la movilidad de los pacientes antesy después del tratamiento. Resultados. La funcionalidad, según la escala ASES (American Shoulder and Elbow Surgeons), pasó de 51,06±7,15 a 76,07±6,6, mientras que el dolor, medido con la escala visual análoga de dolor, pasó de 6,2±0,971 a 3,26±0,93. Todos los participantes recuperaron su movilidad en rotación interna y en aducción horizontal.

Introduction. Access to rehabilitation services to treat painful shoulder symptoms can be limited by multifactorial difficulties in the health care system, but has also recently been restricted by social distancing measures implemented to prevent the spread of COVID-19. Objective. to describe the effect of a teledirected rehabilitation treatment plan to treat posterior shoulder capsule retraction with secondary tendinopathy of the supraspinatus rotator cuff tendon. Methods. Prospective observational descriptive study conducted in 15 patients with posterior shoulder capsule retraction with secondary tendinopathy of the supraspinatus rotator cuff tendon treated with telerehabilitation for five weeks. Functionality, pain and mobility of the patients before and after treatment were evaluated. Results. Functionality, according to the ASES (American Shoulder and Elbow Surgeons) scale, went from 51.06±7.15 to 76.07±6.6, while pain, measured with the visual analogue pain scale, went from 6.2±0.971 to 3.26±0.93. All participants recovered their mobility in internal rotation and horizontal adduction. Conclusions. The implementation of telerehabilitation programs improves functionality, mobility and pain associated with posterior capsular retraction and rotator cuff tendinitis. In this sense, this is a viable treatment alternative in the face of limited access to face physiotherapy services.

Inestabilidad persistente de codo secundaria a luxación traumática con reconstrucción ligamentaria aguda. Caso clínico / Persistent elbow instability secondary to traumatic dislocation with acute ligamentous reconstruction. Clinical case

Introducción: La luxación de codo es un evento frecuente de consulta a urgencias. Su diagnóstico se basa en el examen clínico y radiológico, y su manejo con frecuencia consiste en una reducción cerrada. En algunas ocasiones, la persistencia de inestabilidad posterior a la reducción se convierte en un reto para el médico tratante. Caso clínico: Presentamos el caso de un paciente hombre de 58 años, quien requiere intervenciónaguda por persistencia de luxación simple posterior a tres intentos de reducción cerrada. Aunque se descartó compromiso óseo, la evidencia de inadecuada reducción articular fue la indicación para realizar reconstrucción ligamentaria emergente. Resultados: El paciente requirió manejo quirúrgico para reconstrucción ligamentaria. Después de 6 meses de seguimiento, el paciente presenta ligera rigidez del codo dado por un arco de movilidad de 50 grados. El paciente no presentó nuevos episodios de reluxación posterior a la reconstrucción ligamentaria. Discusión: La luxación simple es la forma de presentación más frecuente en las luxaciones de codo, sin embargo, la estabilidad articular después de realizar una reducción cerrada es muy importante. Una minoría de pacientes requieren ser llevados a procedimientos quirúrgicos para restaurar los estabilizadores ligamentarios y musculares del codo. Se realiza un análisis del caso y se resaltan algunos de los aspectos más importantes bajo la evidencia de la literatura.

Introduction: Elbow dislocation is a frequent emergency consultation event. Its diagnosis is based on clinical and radiological examination, and its management frequently consists of a closed reduction. On some occasions, the persistence of instability after reduction becomes a challenge for the treating physician. Clinical case: We present the case of a 58-year-old male patient, who requires acute intervention due to persistence of simple dislocation after three attempts at closed reduction. Although bone involvement was ruled out, evidence of inadequate joint reduction was the indication to perform emergent ligament reconstruction. Results: The patient required surgical management for ligament reconstruction. After 6 months of follow-up, the patient presents slight elbow stiffness due to a 50-degree arc of mobility. The patient did not present new episodes of redislocation after ligament reconstruction. Discussion: Simple dislocation is the most common presentation of elbow dislocations; however, joint stability after performing a closed reduction is very important. A minority of patients require surgical procedures to restore the ligamentous and muscular stabilizers of the elbow. An analysis of the case is carried out and some of the most important aspects are highlighted based on the evidence of the literature.

Neurotización del nervio circunflejo por vía axilar, estudio cadavérico / Neurotization of the circumflex nerve through an axillary approach, cadaveric study

Objetivo Confirmar factibilidad técnica de la neurotización del nervio axilar por la rama motora de la porción larga del tríceps con el fin de definir la anatomía quirúrgica de los nervios radial y axilar. Materiales y métodos Veinte hombros de cadáver fueron intervenidos para transferencia de la rama del Nervio Radial para la porción larga del tríceps a la rama anterior del Nervio Axilar por abordaje axilar. Se confirmó la escogencia correcta del nervio receptor por abordaje posterior. Resultados Se logró una disección adecuada de la primera rama motora del nervio radial del nervio axilar y de la rama anterior del Nervio Axilar. El origen de la rama motora se encontró en promedio a 3,8mm (+/- 7,3mm) distal al borde superior del tendón del dorsal ancho. El nervio axilar se encontró cefálico al borde superior del dorsal ancho a una distancia promedio de 11,3mm (+/-2,13mm) y distal al redondo menor 3.05mm (+/- 1,3mm), sutura con la primera rama del radial en el 100% de los casos sin tensión y se confirmó la adecuada transferencia en todos los casos. Conclusión La neurotización del nervio axilar con la primera rama del nervio radial se logró con éxito en el 100% por vía axilar. Este abordaje es adecuado, evitando tener que realizar cambios de posición a prono y doble abordaje, y si se requiere procedimientos adicionales de reconstrucción en el mismo tiempo quirúrgico tipo Oberlin y exploraciones supraclaviculares del plexo braquial se pueden realizar sin cambio de posición.

Objective To confirm the technical feasibility of neurotization of the axillary nerve by the motor branch of the long head of the triceps in order to define the surgical anatomy of the radial and axillary nerves. Materials and method Twenty cadaver shoulders were operated on for transfer of the radial nerve branch for the long head of the triceps to the anterior branch of the axillary nerve by axillary approach. The correct choice of the receiving nerve was confirmed by posterior approach. Results An adequate dissection of the first motor branch of the radial nerve of the axillary nerve and of the anterior branch of the Axillary Nerve was achieved, The origin of the motor branch was found on average at 3.8mm (+/−7.3mm) distal to the superior border of the latissimus dorsi tendon. The axillary nerve was found 11.3mm (+/−2.13mm) cephalad to the upper border of the latissimus dorsi and 3.05mm (+/−1.3mm) distal to the teres minor. A tensionless coaptation was obtained in all cases. Conclusion Neurotization of the axillary nerve with the first branch of the radial nerve was successfully achieved through the axillary approach. This approach is adequate, avoiding position change to prone and double approach, and if additional reconstruction procedures are required at the same surgical time, Oberlin type and supraclavicular explorations of the brachial plexus can be performed without changing position.

Defectos oseos glenohumerales: Un recorrido por los avances diagnósticos y terapéuticos durante los últimos 20 años / Glenohumeral bone defects. A review of the diagnostic and therapeutic advances over the last 20 years

Introducción: El abordaje y el tratamiento de los defectos óseos glenohumerales han evolucionado con la intención de brindar un manejo más individualizado para los pacientes. Sin embargo, hasta la fecha, no existen artículos que recopilen dichos avances históricos. Objetivo: Describir la bibliografía más relevante sobre el análisis diagnóstico y las opciones terapéuticas de los defectos óseos glenohumerales en los últimos 20 años. Materiales y métodos: Se realizó una búsqueda en la base de datos PubMed con los términos "Glenoid defect", "Humeral defect", "Shoulder instability" y "Glenoid track", filtrada por año desde 2000 hasta 2021. Se incluyeron estudios publicados en inglés y español, de pacientes adultos. Resultados: En la búsqueda, se revisaron 56 artículos según los criterios planteados. Se llevó a cabo una revisión narrativa cronológica sobre el abordaje de los defectos óseos glenohumerales en inestabilidad anterior. Conclusiones: Los avances tecnológicos han permitido desarrollar algoritmos de evaluación y manejo dirigidos a lograr los mejores desenlaces según las características de cada paciente. La bibliografía actual recomienda el tratamiento quirúrgico basado en la medición objetiva de los defectos óseos glenohumerales, para lo cual la artroscopia y la tomografía con reconstrucción 3D ofrecen la cuantificación más acertada. Nivel de Evidencia: IV Revisión narrativa

Introduction: The approach and treatment of glenohumeral bone defects have evolved intending to provide more individualized management for patients. However, to date, there are no articles that compile these historical advances. Objective: To describe the most relevant literature on the diagnostic analysis and therapeutic options for glenohumeral bone defects reported in the last 20 years. Materials and methods: A search was conducted in the PubMed database with the terms "Glenoid defect", "Humeral defect", "Shoulder instability" and "Glenoid track", filtered by year from 2000 to 2021. Studies published in English and Spanish, involving adult patients, were included. Results: We reviewed a total of 56 articles. A narrative chronological review of the approach to glenohumeral bone defects in anterior instability was performed. Conclusions: Technological advances have allowed the development of evaluation and management algorithms aimed at achieving the best outcomes according to the characteristics of each patient. To date, the current literature recommends surgical treatment of instability based on the objective measurement of glenohumeral bone defects, for which arthroscopy and 3D reconstruction tomography offer the most accurate quantification. Level of Evidence: IV Narrative review

Evaluación de factores asociados a formación de colecciones intraabdominales en apendicectomía monopuerto para apendicitis aguda complicada.

OBJETIVO: Comparar los desenlaces entre la apendicectomía por laparoscopia por puerto único y multipuerto, y establecer si existe diferencia en el riesgo de colección intraabdominal posoperatoria. MÉTODO: Se realizó un estudio retrospectivo, observacional, mediante 116 historias clínicas de pacientes llevados a apendicectomía laparoscópica por único puerto y multipuerto en dos centros médicos. RESULTADOS: Desarrollaron colección intraabdominal 12 (10.3%) pacientes. No se encontraron diferencias entre ambas técnicas en cuanto al desarrollo de colección intraabdominal (p = 0.242), no hubo diferencia entre ambas técnicas en cuanto a sangrado intraoperatorio (p = 0.012) y el tiempo quirúrgico fue mayor en el grupo de puerto único (17.4 minutos en promedio). El 62.5% de los pacientes con sangrado > 50 ml desarrollaron colección intraabdominal. CONCLUSIONES: No se evidenció superioridad de ninguna de las dos intervenciones en apendicitis complicada, pero sí se confirma que la apendicectomía laparoscópica por puerto único es un procedimiento seguro, factible, no inferior y con tasas similares de complicaciones en comparación con la técnica convencional de apendicectomía laparoscópica. OBJECTIVE: To compare the decreases between the appendectomy by single port vs. multiport laparoscopy and to establish if there is a difference in the risk of postoperative intra-abdominal collection. METHOD: Retrospective study was carried out using 116 medical records of patients undergoing laparoscopic appendectomy through a single port and multiport in two medical centers. RESULTS: 12 (10.3%) patients developed an abdominal collection. No differences were found between the two techniques in terms of intra-abdominal collection development (p = 0.242), there was no difference between the two techniques in terms of intraoperative bleeding (p = 0.012), the surgical time was greater in the single-port group (17.4 min on average). 62.5% of patients with bleeding > 50 mL developed intra-abdominal collection. CONCLUSIONS: There was no evidence of superiority of either of the two interventions in complicated appendicitis, but it does confirm that single-port laparoscopic appendectomy is a safe, feasible, noninferior procedure and with similar complication rates compared to the conventional laparoscopic appendectomy technique.

A meta-analysis of the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma.

BACKGROUND: We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. METHODS: A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework. RESULTS: We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results. CONCLUSION: This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis, level II.

The immunogenetic diversity of the HLA system in Mexico correlates with underlying population genetic structure.

We studied HLA class I (HLA-A, -B) and class II (HLA-DRB1, -DQB1) allele groups and alleles by PCR-SSP based typing in a total of 15,318 mixed ancestry Mexicans from all the states of the country divided into 78 sample sets, providing information regarding allelic and haplotypic frequencies and their linkage disequilibrium, as well as admixture estimates and genetic substructure. We identified the presence of 4268 unique HLA extended haplotypes across Mexico and find that the ten most frequent (HF > 1%) HLA haplotypes with significant linkage disequilibrium (Δ'≥0.1) in Mexico (accounting for 20% of the haplotypic diversity of the country) are of primarily Native American ancestry (A*02~B*39~DRB1*04~DQB1*03:02, A*02~B*35~DRB1*08~DQB1*04, A*68~B*39~DRB1*04~DQB1*03:02, A*02~B*35~DRB1*04~DQB1*03:02, A*24~B*39~DRB1*14~DQB1*03:01, A*24~B*35~DRB1*04~DQB1*03:02, A*24~B*39~DRB1*04~DQB1*03:02, A*02~B*40:02~DRB1*04~DQB1*03:02, A*68~B*35~DRB1*04~DQB1*03:02, A*02~B*15:01~DRB1*04~DQB1*03:02). Admixture estimates obtained by a maximum likelihood method using HLA-A/-B/-DRB1 as genetic estimators revealed that the main genetic components in Mexico as a whole are Native American (ranging from 37.8% in the northern part of the country to 81.5% in the southeastern region) and European (ranging from 11.5% in the southeast to 62.6% in northern Mexico). African admixture ranged from 0.0 to 12.7% not following any specific pattern. We were able to detect three major immunogenetic clusters correlating with genetic diversity and differential admixture within Mexico: North, Central and Southeast, which is in accordance with previous reports using genome-wide data. Our findings provide insights into the population immunogenetic substructure of the whole country and add to the knowledge of mixed ancestry Latin American population genetics, important for disease association studies, detection of demographic signatures on population variation and improved allocation of public health resources.

Origin and Health Status of First-Generation Africans from Early Colonial Mexico.

The forced relocation of several thousand Africans during Mexico's historic period has so far been documented mostly through archival sources, which provide only sparse detail on their origins and lived experience. Here, we employ a bioarchaeological approach to explore the life history of three 16th century Africans from a mass burial at the San José de los Naturales Royal Hospital in Mexico City. Our approach draws together ancient genomic data, osteological analysis, strontium isotope data from tooth enamel, δ13C and δ15N isotope data from dentine, and ethnohistorical information to reveal unprecedented detail on their origins and health. Analyses of skeletal features, radiogenic isotopes, and genetic data from uniparental, genome-wide, and human leukocyte antigen (HLA) markers are consistent with a Sub-Saharan African origin for all three individuals. Complete genomes of Treponema pallidum sub. pertenue (causative agent of yaws) and hepatitis B virus (HBV) recovered from these individuals provide insight into their health as related to infectious disease. Phylogenetic analysis of both pathogens reveals their close relationship to strains circulating in current West African populations, lending support to their origins in this region. The further relationship between the treponemal genome retrieved and a treponemal genome previously typed in an individual from Colonial Mexico highlights the role of the transatlantic slave trade in the introduction and dissemination of pathogens into the New World. Putting together all lines of evidence, we were able to create a biological portrait of three individuals whose life stories have long been silenced by disreputable historical events.

Low intra-operative diagnostic accuracy does not affect postoperative treatment of acute appendicitis.

BACKGROUND: The intra-operative classification of appendicitis defines postoperative treatment. The correct designation can influence patient recovery, complications and hospital costs. Recent research has shown that intra-operative classification criteria varies among surgeons, and is not always the same as the pathologist's report. Classification accuracy can lower costs by preventing unnecessary treatment or sub-optimal interventions. METHODS: During a period of 4 months, N = 133 appendix specimens were received and evaluated by the pathology department of a single teaching hospital. Five surgeons extracted the specimens and one experienced pathologist drew the histopathology reports. A comparison between the surgeons' classifications and the pathologist's was made. Classification accuracy was determined and statistical analyses was performed using chi-square, and p values were obtained. A p < 0.05 was considered significant. RESULTS: A total of N = 133 specimens were obtained, 127 belonged to patients following emergency surgery due to acute abdominal pain; the other six were from elective hemi-colectomies for right colonic adenocarcinomas, and were not included. Of the 127 specimens analyzed, 14 (11%) were negative, 21 (16.5%) were edematous, 81 (63.7%) were phlegmonous and 11 (8.6%) were gangrenous. A total of 18 (14%) perforated appendices were also reported. Surgical accuracy was 60.6% (N = 67) with a statistically significant p < 0.001. Only five patients with incorrect intraoperative classifications received unnecessary or lacked treatment. CONCLUSIONS: An overall accuracy of 60.6% is seen when the surgical classification is compared to the pathological classification. Although the surgeons' accuracy is low when comparing intra-operative versus histopathological classification, this variation in designation does not affect postoperative treatment significantly.

Pancreatoduodenectomía de urgencia: Whipple o no Whipple, esa es la cuestión / Emergency pancreatoduodenectomy: Whipple or no Whipple, that is the question

Introducción. La pancreatoduodenectomía, u operación de Whipple, fue descrita por Codivilla en 1898 como tratamiento para el cáncer de la cola del páncreas. Con aportes posteriores se ha perfeccionado la técnica, lo cual ha permitido su aplicación en diferentes circunstancias y ha contribuido a la supervivencia de muchos pacientes. Sin embargo, su uso poco frecuente y las dificultades para practicarla, hacen complicado decidir si se utiliza o no la técnica de Whipple. Caso clínico. Se presenta y analiza el caso de un paciente que ingresó a urgencias por un trauma penetrante de abdomen con una grave lesión pancreatoduodenal; se le practicó de urgencia una operación de Whipple en el servicio de cirugía general de una institución de tercer nivel de Bogotá, y se obtuvieron resultados satisfactorios. Además, se hace una revisión exhaustiva de la literatura científica. Discusión y conclusiones. La pancreatoduodenectomía de urgencia es una cirugía compleja que supone un reto quirúrgico, en el cual se deben tener en cuenta el estado hemodinámico, el estado ácido-base y la presencia o ausencia de coagulopatía, a la hora de adoptar una conducta definitiva

Introduction: Pancreaticoduodenectomy is a procedure first described by Codivilla in 1898 for the management of pancreatic cancer. With subsequent contributions the technique has been perfected allowing its application in other contexts leading to the survival of many patients. However, the low demand for the procedure and the difficulties in doing so makes the decision of whether to take or not to take the patient to a Whipple surgery a very complex matter. Case report: We present the case of a patient who arrived at the emergency room with penetrating abdominal trauma with pancreaticoduodenal injury in whom the Whipple procedure was performed urgently by the general surgery service at a third level of care institution in Bogotá, Colombia, with excellent results. Discussion and conclusions: Emergency pancreatoduodenectomy is a complex procedure that represents a surgical challenge in which the hemodynamic state, the acid base balance and the presence of coagulopathy need to be considered when assuming some definitive conduct. A comprehensive review of the scientific literature is presented

Apendicitis aguda izquierda: presentación infrecuente de una enfermedad frecuente: Revisión de la literatura y reporte de un caso / Left-sided acute appendicitis: infrequent presentation of an infrequent entity. Literature review and case report

La apendicitis aguda izquierda es infrecuente y requiere una alta sospecha diagnóstica, estudios imaginológicos complementarios y un tratamiento quirúrgico definitivo. El retraso en el diagnóstico conlleva múltiples complicaciones y dificultades durante el procedimiento quirúrgico. Se presenta una revisión de la literatura científica a propósito de un caso clínico de apendicitis izquierda aguda secundaria a una malrotación intestinal, con sus manifestaciones clínicas, estudios diagnósticos y tratamiento.

Left-sided acute appendicitis is a rare entity that requires a high index of suspicion, and complementary imaging studies for a definitive surgical treatment. Delay in diagnosis results in multiple complications and difficulties during the surgical procedure. We present a review of the literature, the clinical manifestations, the diagnostic studies and treatment, and report a clinical case of left-sided acute appendicitis secondary to intestinal malrotation.

Endoscopia y esófago de Barrett: ¿en qué fallamos? / Endoscopy and Barrett's esophagus: where did we fail?

Introducción. El esófago de Barrett es una metaplasia intestinal especializada, cuyo diagnóstico se basa en la identificación de la mucosa de color salmón en el esófago, la apropiada ejecución de las biopsias y la confirmación histológica. Objetivos. Determinar la eficacia de la inspección endoscópica en comparación con los resultados de histopatología y la precisión de la descripción visual del esófago de Barrett en Colombia en comparación con otros países. Materiales y métodos. Se trata de un estudio internacional multicéntrico, con revisión prospectiva de bases de datos. Se evaluaron los hallazgos endoscópicos de 347 pacientes con sospecha de esófago de Barrett y se compararon con los reportes de histopatología. Además, se determinó la frecuencia de la adecuada descripción de los hallazgos endoscópicos y el apropiado protocolo de biopsias en tres países. Resultados. La presencia de esófago de Barrett se confirmó en 133 de 347 pacientes (38 %). Hubo metaplasia intestinal en 118 de 133 pacientes (89 %) y, displasia de bajo grado, en 15 (11 %). La morfología del esófago de Barrett se describió en 262 de 347 pacientes (76 %) y, la longitud, en 205 de ellos (59 %). La media de biopsias fue de 3,6±2,2. Conclusiones. Según los resultados, la inspección visual para el diagnóstico del esófago de Barrett es poco eficaz y se hizo una adecuada descripción de los hallazgos endoscópicos en cerca de la mitad de los pacientes con sospecha de esófago de Barrett en Colombia. Este estudio sugiere la necesidad de hacerle seguimiento a las guías de la American Gastroenterological Association para optimizar el diagnóstico del esófago de Barrett.

Background: Barrett esophagus is a specialized intestinal metaplasia. The diagnosis is based on visualization of a salmon colored mucosa, the properly executed biopsies and the pathology confirmation. Aims: The aims of this study were to determine the efficacy of the endoscopic inspection as compared with the histopathology report and the precision of the visual description of the Barrett's esophagus in Colombia in comparison with other nations. Methods: This is an international multicentric study with prospective review of the data bases. We evaluated the endoscopic findings of 347 patients in whom the endoscopist thought that Barrett´s esophagus was present, and compared them to the pathology results. In addition, we assessed the frequency of an adequate description of the endoscopic findings and the observance of a due biopsy protocol in three countries. Results: The presence of Barrett's esophagus was confirmed in 133 of the 347 patients (38%). Metaplasia was present in 118 of the 133 patients (89%) and low grade dysplasia in 15 patients (11%). The morphology of Barrett´s esophagus was described in 262 of the 347 patients (76%), and the length was reported in 205 of these patients (59%). An average of 3.6±2.2 biopsies were taken. Conclusions: According to our results, visual inspection for the diagnosis of Barrett's esophagus has a low efficacy, and a precise description of the Barretts esophagus was not done in around a half of the patients in Colombia. This study suggests the need for more strict observation of the American Gastroenterological Association and the American College of Gastroenterology guidelines by physicians in order to optimize the diagnosis of Barretts esophagus.