Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture.

Objective: To improve susceptibility profiles of nosocomial bacteria, identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP). Methodology: This is a retrospective, observational, analytical cohort study, comparing infectious complications between patients undergoing fURS with negative UC who received EP versus SP. We include patients with susccessfull fURS, <20-mm stones and complete information. Results: Overall, 10.3% of patients had complications, 7.2% of patients had postoperative urinary infection, 1.8% had upper urinary tract infection (UTI) and 1.4% had urinary sepsis. Lower UTI were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR = 2.8; 95% CI: 1.10-7.37, p = 0.030). The risk of upper UTI and sepsis did not show significant differences. A total of 69% patients with postoperative infection had isolated multidrug-resistant bacteria (MDRB) in the UC, with a higher risk in patients with extended prophylaxis (RR = 3.1; 95% CI: 1.33-7.59, p = 0.009). Conclusions: Patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of low UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60-min preoperative prophylaxis.

Negative log-binomial model with optimal robust variance to estimate the prevalence ratio, in cross-sectional population studies.

BACKGROUND: Cross-sectional studies are useful for the estimation of prevalence of a particular event with concerns in specific populations, as in the case of diseases or other public health interests. Most of these studies have been carried out with binary binomial logistic regression model which estimates OR values that could be overestimated due to the adjustment of the model. Thus, the selection of the best multivariate model for cross-sectional studies is a priority to control the overestimation of the associations. METHODS: We compared the precision of the estimates of the prevalence ratio (PR) of the negative Log-binomial model (NLB) with Mantel-Haenszel (MH) and the regression models Cox, Log-Poisson, Log-binomial, and the OR of the binary logistic regression in population-based cross-sectional studies. The prevalence from a previous cross-sectional study carried out in Colombia about the association of mental health disorders with the consumption of psychoactive substances (e.g., cocaine, marijuana, cigarette, alcohol and risk of consumption of psychoactive substances) were used. The precision of the point estimates of the PR was evaluated for the NLB model with robust variance estimates, controlled with confounding variables, and confidence interval of 95%. RESULTS: The NLB model adjusted with robust variance showed accuracy in the measurements of crude PRs, standard errors of estimate and its corresponding confidence intervals (95%CI) as well as a high precision of the PR estimate and standard errors of estimate after the adjustment of the model by grouped age compared with the MH PR estimate. Obtained PRs and 95%CI entre NLB y MH were: cocaine consumption (2.931,IC95%: 0.723-11.889 vs. 2.913, IC95%: 0.786-12.845), marijuana consumption (3.444, IC95%: 1.856-6.391 vs. 3.407, IC95%: 1.848, 6.281), cigarette smoking (2.175,IC95%: 1.493, 3.167 vs. 2.209, IC95%: 1.518-3.214), alcohol consumption (1.243,IC95%: 1.158-1.334 vs. 1.241, IC95%: 1.157-1.332), and risk of consumption of psychoactive substances (1.086, IC95%: 1.047-1.127 vs. 1.086, IC95%: 1.047, 1.126). The NLB model adjusted with robust variance showed mayor precision when increasing the prevalence, then the other models with robust variance with respect to MH. CONCLUSIONS: The NLB model with robust variance was shown as a powerful strategy for the estimation of PRs for cross-sectional population-based studies, as high precision levels were identified for point estimators, standard errors of estimate and its corresponding confidence intervals, after the adjustment of confounding variables. In addition, it does not represent convergence issues for high prevalence cases (as it occur with the Log-binomial model) and could be considered in cases of overdispersion and with greater precision and goodness of fit than the other models with robust variance, as it was shown with the data set of the cross-sectional study used in here.

A prospective non-fatal injuries assessment: A multivariate analysis in medical-legal examinations.

OBJECTIVE: To prospectively determine injury recovery time in the medical-legal examinations of non-fatal injuries and their associated factors, carried out by the National Institute of Legal Medicine and Forensic Sciences of Colombia to create a multivariate analysis. METHODS: A prospective medical-legal assessment of non-fatal injuries was carried out on 281 individuals with complete follow-up, in which the observational unit of analysis was the most serious injury. Variables, such as sex, circumstances of the injury, the mechanism that caused the injury, medical certificate of incapacity to work, among others were related to the injury recovery time, measured in days. The Kruskal Wallis (K-W) ANOVA and a multivariate analysis using the ordinal regression model were applied. RESULTS: In the multivariate analysis, the factors most associated with longer recovery time were the extent of joint damage (CR95%:1.47-5.94,p = 0.0001) and bone damage (CR95%:2.92-7.42,p < 0.001). In terms of circumstances of the injury, traffic accidents (CR95%:1.03-2.96,p < 0.001), medical-legal impairments (CR95%:0.34-2.19,p = 0.007), and complications of the primary injury (CR95%: 1.18-2.57,p < 0.001) had the greatest impact on recovery time. Others factors that significantly impacted injury recovery time are surgical treatments (IC95%: 0.33-3.26,p = 0.0164) and delayed treatment (CR95%:1.41-4.72,p < 0.001). A direct correlation (significant and moderately strong) was found between the recovery time of the injury and the days of incapacity for work (r = 0.802, p < 0.001). CONCLUSION: This prospective analysis determined which variables were most strongly related to the medical-legal assessment of non-fatal injuries and the recovery time of said injuries. Further studies aimed at improving the strategies to help individuals complete the legal process are required.

Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes.

BACKGROUND: Nonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years. METHODS: A retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50-69 years, 70-89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien-Dindo scale. RESULTS: The patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07-20.13), presence of cholecystitis (RR 8.2 CI95% 1.29-51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10-1.40) were the variables that presented statistically significant differences as risk factors for mortality. CONCLUSION: Cholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.

Surgical mortality in patients in extremis: futility in emergency abdominal surgery.

BACKGROUND: The number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. METHODS: A retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. RESULTS: A total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died. CONCLUSIONS: All available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.

Survival Outcomes of Hepatectomy in Gastric Cancer Liver Metastasis: A Systematic Review and Meta-Analysis.

Gastric cancer liver metastasis (GCLM) is a contraindication for surgical treatment in current guidelines. However, the results of recent studies are questioning this paradigm. We assessed survival outcomes and their predictors following hepatectomy for GCLM in a systematic review of studies published from 2000 to 2022 according to PRISMA guidelines. We identified 42,160 references in four databases. Of these, 55 articles providing data from 1990 patients fulfilled our criteria and were included. We performed a meta-analysis using random-effects models to assess overall survival (OS) and disease-free survival (DFS) at one, three, and five years post-surgery. We studied the impact of potential prognostic factors on survival outcomes via meta-regression. One, three, and five years after surgery, OS was 69.79%, 34.79%, and 24.68%, whereas DFS was 41.39%, 23.23%, and 20.18%, respectively. Metachronous presentation, well-to-moderate differentiation, small hepatic tumoral size, early nodal stage, R0 resection, unilobar compromisation, and solitary lesions were associated with higher overall survival. Metachronous presentation, smaller primary tumoral size, and solitary metastasis were linked to longer DFS. The results of our meta-analysis suggest that hepatectomy leads to favorable survival outcomes in patients with GCLM and provides data that might help select patients who will benefit most from surgical treatment.

Quick Sequential Organ Failure Assessment, Sequential Organ Failure Assessment, and Procalcitonin for Early Diagnosis and Prediction of Death in Elderly Patients with Suspicion of Sepsis in the Emergency Department, Based on Sepsis-3 Definition.

BACKGROUND: Sepsis is a disease with a high mortality rate without prompt treatment. However, this entity is difficult to diagnose in the elderly population in the emergency room; for this reason, it is necessary to have diagnostic tools for early detection. OBJECTIVE: The aim of the study was to determine the highest diagnostic yield of procalcitonin (PCT), Quick Sequential Organ Failure Assessment (qSOFA), and Sequential Organ Failure Assessment (SOFA) for sepsis (based on the sepsis-3 consensus), on admission at the emergency department, in those older than 65 years. METHODS: This is a diagnostic test study of a historical cohort of 65-year-old patients with suspected sepsis. RESULTS: In the sample of 179 patients, 53.6% had confirmed sepsis. Significant differences were found (p < 0.0001), with a greater diagnostic and predictive capacity of PCT for the diagnosis of sepsis (receiver operating characteristics curve area [area under the curve (AUC) = 0.883, 95% CI: 0.835-0.931] than qSOFA (AUC = 0.559, 95% CI: 0.485-0.663) and SOFA (AUC = 0.662, 95% CI: 0.584-0.739); these results were similar in the cohort of patients ≥75 years. In positive PCT(≥0.5 ng/mL), the sensitivity was 71.8% (95% CI: 62.36-81.39), specificity of 89.1% (95% CI: 81.87-96.45%), V+ 88.4% (95% CI: 80.73-96.19%), V- of 73.2% (95% CI: 64.14-82.39%), positive likelihood ratio of 6.63 (95% CI: 3.53-12.44), and negative likelihood ratio of 0.32 (95% CI: 0.23-0.44); these results were similar in the cohort of patients ≥75 years. Lactate ≥2 mmol/L (RR = 1.659 [95% CI: 1.002-2.747]) and PCT ≥0.5 ng/mL (RR = 1.942 [95% CI: 1.157-3.261]) showed a significant association with in-hospital mortality. CONCLUSION: In the elderly population with suspicion of infection on admission to the emergency department, qSOFA presents a low diagnostic performance of confirmed sepsis and in-hospital mortality, for which other tools with higher diagnostic and prognostic performance should be added, such as PCT and lactate.

Risk factor for breast cancer development under exposure to bovine leukemia virus in Colombian women: A case-control study.

Viruses have been implicated in cancer development in both humans and animals. The role of viruses in cancer is typically to initiate cellular transformation through cellular DNA damage, although specific mechanisms remain unknown. Silent and long-term viral infections need to be present, in order to initiate cancer disease. In efforts to establish a causative role of viruses, first is needed to demonstrate the strength and consistency of associations in different populations. The aim of this study was to determine the association of bovine leukemia virus (BLV), a causative agent of leukemia in cattle, with breast cancer and its biomarkers used as prognosis of the severity of the disease (Ki67, HER2, hormonal receptors) in Colombian women. An unmatched, observational case-control study was conducted among women undergoing breast surgery between 2016-2018. Malignant samples (n = 75) were considered as cases and benign samples (n = 83) as controls. Nested-liquid PCR, in-situ PCR and immunohistochemistry were used for viral detection in blood and breast tissues. For the risk assessment, only BLV positive samples from breast tissues were included in the analysis. BLV was higher in cases group (61.3%) compared with controls (48.2%), with a statistically significant association between the virus and breast cancer in the unconditional logistic regression (adjusted-OR = 2.450,95%CI:1.088-5.517, p = 0.031). In this study, BLV was found in both blood and breast tissues of participants and an association between breast cancer and the virus was confirmed in Colombia, as an intermediate risk factor.

Co-Circulation of Bovine Leukemia Virus Haplotypes among Humans, Animals, and Food Products: New Insights of Its Zoonotic Potential.

Bovine leukemia virus (BLV) is the causative agent of leukemia/lymphoma in cattle. It has been found in humans and cattle-derived food products. In humans, it is described as a potential risk factor for breast cancer development. However, the transmission path remains unclear. Here, a molecular epidemiology analysis was performed to identify signatures of genetic flux of BLV among humans, animals, and food products. Sequences obtained from these sources in Colombia were used (n = 183) and compared with reference sequences available in GenBank. Phylogenetic reconstruction was performed in IQ-TREE software with the maximum likelihood algorithm. Haplotype (hap) distribution among the population was carried out with a median-joining model in Network5.0. Recombination events were inferred using SplitsTree4 software. In the phylogenetic analysis, no specific branches were identified for the Colombian sequences or for the different sources. A total of 31 haps were found, with Hap 1, 4, 5 and 7 being shared among the three sources of the study. Reticulation events among the different sources were also detected during the recombination analysis. These results show new insights about the zoonotic potential of BLV, showing evidence of genetic flux between cattle and humans. Prevention and control strategies should be considered to avoid viral dissemination as part of the One Health program policies.

Detection of nutritional risk and hospital stay in the hospitalized elderly adult / Detección del riesgo nutricional y estancia hospitalaria en el anciano hospitalizado

Background and aims: a high nutritional risk can independently be associated with a longer hospital stay in elderly patients. This study aims to establish the prevalence of the risk of malnutrition and its associated factors in a high-complexity level hospital in Bogotá, Colombia, during 2018. Methods: a cross-sectional study. The prevalence of the risk of malnutrition was measured using a malnutrition-screening tool (MST), and the association with hospital stage, age, and patient diagnoses was assessed. Results: a total of 7,192 patients comprised the cohort. Age range was 61 to 108 years, with an average of 77.1 ± 9.2 years, and subjects were mostly female (55.5 %). We identified as main conditions urinary tract infections (8.4 %), congestive heart failure (5.4 %), and chronic obstructive pulmonary disease with an acute exacerbation (4.6 %). The prevalence of the risk of malnutrition was 41.4 %, significantly associated with longer hospital stays (p < 0.001), older age (p < 0.001), and a diagnosis of delirium (OR = 5.98, 95 % CI: 2.78 to 12.86), diarrhea and gastroenteritis (OR = 5.01, 95 % CI: 2.44 to 10.32), gastrointestinal hemorrhage (OR = 4.44, 95 % CI: 2.38 to 8.28), specified pneumonia (OR = 4.43, 95% CI: 2.11 to 9.30), and high blood pressure (3.94, 95 % CI: 2.07 to 7.50). Other diagnoses included abdominal pain (other) (OR = 3.80, 95 % CI: 1.81 to 7.99), urinary tract infections (OR = 3.64, 95 % CI: 2.07 to 6.24), acute bronchitis (OR = 3.22, 95 % CI: 1.56 to 6.65), and bacterial pneumonia (OR = 3.02, 95 % CI: 1.65 to 5.55). (AU)

Antecedentes y objetivos: el alto riesgo nutricional puede asociarse independientemente a una estancia hospitalaria más prolongada en los pacientes ancianos. Este estudio tiene por objetivo establecer la prevalencia del riesgo de malnutrición y sus factores asociados en un hospital de alta complejidad de Bogotá (Colombia) durante 2018. Métodos:este fue un estudio transversal. Se determinó la prevalencia del riesgo de malnutrición mediante la herramienta de detección MST y se evaluó la asociación con la estancia hospitalaria, la edad y el diagnóstico del paciente. Resultados: en total, 7192 pacientes conformaron la cohorte. El rango de edad era de 61 a 108 años, con un promedio de 77,1 ± 9,2 años, siendo los sujetos en su mayoría de sexo femenino (55,5 %). Se identificaron como condiciones principales las infecciones del tracto urinario (8,4 %), la insuficiencia cardiaca congestiva (5,4 %) y la enfermedad pulmonar obstructiva crónica (4,6 %). La prevalencia del riesgo de desnutrición fue del 41,4 %, asociada a las estancias hospitalarias prolongadas (p < 0,001), la edad avanzada (p < 0,001) y los diagnósticos de delirium (OR = 5,98, IC 95 %: 2,78 a 12,86), diarrea y gastroenteritis (OR = 5.01, IC 95 %: 2.44 a 10.32), hemorragia gastrointestinal (OR = 4.44, IC 95 %: 2.38 a 8.28), neumonía específica (OR = 4.43, IC 95 %: 2.11 a 9.30) e hipertensión arterial (3.94, IC 95 %: 2.07 a 7.50). Otros diagnósticos asociados fueron: dolor abdominal (otros) (OR = 3.80, IC 95 %: 1.81 a 7.99), infecciones del tracto urinario (OR = 3.64, IC 95 %: 2.07 a 6.24), bronquitis aguda (OR = 3.22, IC 95 %: 1.56 a 6.65) y neumonía bacteriana (OR = 3.02, IC 95 %: 1.65 a 5.55). (AU)

Detection of nutritional risk and hospital stay in the hospitalized elderly adult.

INTRODUCTION: Background and aims: a high nutritional risk can independently be associated with a longer hospital stay in elderly patients. This study aims to establish the prevalence of the risk of malnutrition and its associated factors in a high-complexity level hospital in Bogotá, Colombia, during 2018. Methods: a cross-sectional study. The prevalence of the risk of malnutrition was measured using a malnutrition-screening tool (MST), and the association with hospital stage, age, and patient diagnoses was assessed. Results: a total of 7,192 patients comprised the cohort. Age range was 61 to 108 years, with an average of 77.1 ± 9.2 years, and subjects were mostly female (55.5 %). We identified as main conditions urinary tract infections (8.4 %), congestive heart failure (5.4 %), and chronic obstructive pulmonary disease with an acute exacerbation (4.6 %). The prevalence of the risk of malnutrition was 41.4 %, significantly associated with longer hospital stays (p < 0.001), older age (p < 0.001), and a diagnosis of delirium (OR = 5.98, 95 % CI: 2.78 to 12.86), diarrhea and gastroenteritis (OR = 5.01, 95 % CI: 2.44 to 10.32), gastrointestinal hemorrhage (OR = 4.44, 95 % CI: 2.38 to 8.28), specified pneumonia (OR = 4.43, 95% CI: 2.11 to 9.30), and high blood pressure (3.94, 95 % CI: 2.07 to 7.50). Other diagnoses included abdominal pain (other) (OR = 3.80, 95 % CI: 1.81 to 7.99), urinary tract infections (OR = 3.64, 95 % CI: 2.07 to 6.24), acute bronchitis (OR = 3.22, 95 % CI: 1.56 to 6.65), and bacterial pneumonia (OR = 3.02, 95 % CI: 1.65 to 5.55). Conclusion: the prevalence of the risk of malnutrition in our institution is approximately one in two patients, with a significant association to increased hospital stay ≥ 8 days, patient age ≥ 80 years, and mainly diagnoses of delirium, diarrhea, and gastroenteritis of suspected infectious etiology.

INTRODUCCIÓN: Antecedentes y objetivos: el alto riesgo nutricional puede asociarse independientemente a una estancia hospitalaria más prolongada en los pacientes ancianos. Este estudio tiene por objetivo establecer la prevalencia del riesgo de malnutrición y sus factores asociados en un hospital de alta complejidad de Bogotá (Colombia) durante 2018. Métodos: este fue un estudio transversal. Se determinó la prevalencia del riesgo de malnutrición mediante la herramienta de detección MST y se evaluó la asociación con la estancia hospitalaria, la edad y el diagnóstico del paciente. Resultados: en total, 7192 pacientes conformaron la cohorte. El rango de edad era de 61 a 108 años, con un promedio de 77,1 ± 9,2 años, siendo los sujetos en su mayoría de sexo femenino (55,5 %). Se identificaron como condiciones principales las infecciones del tracto urinario (8,4 %), la insuficiencia cardiaca congestiva (5,4 %) y la enfermedad pulmonar obstructiva crónica (4,6 %). La prevalencia del riesgo de desnutrición fue del 41,4 %, asociada a las estancias hospitalarias prolongadas (p < 0,001), la edad avanzada (p < 0,001) y los diagnósticos de delirium (OR = 5,98, IC 95 %: 2,78 a 12,86), diarrea y gastroenteritis (OR = 5.01, IC 95 %: 2.44 a 10.32), hemorragia gastrointestinal (OR = 4.44, IC 95 %: 2.38 a 8.28), neumonía específica (OR = 4.43, IC 95 %: 2.11 a 9.30) e hipertensión arterial (3.94, IC 95 %: 2.07 a 7.50). Otros diagnósticos asociados fueron: dolor abdominal (otros) (OR = 3.80, IC 95 %: 1.81 a 7.99), infecciones del tracto urinario (OR = 3.64, IC 95 %: 2.07 a 6.24), bronquitis aguda (OR = 3.22, IC 95 %: 1.56 a 6.65) y neumonía bacteriana (OR = 3.02, IC 95 %: 1.65 a 5.55). Conclusión: la prevalencia del riesgo de desnutrición en la institución es aproximadamente de uno de cada dos pacientes, con una asociación significativa al aumento de la estancia hospitalaria superior a 8 días, a la edad del paciente mayor de 80 años y, principalmente, a los diagnósticos de delirium, diarrea y gastroenteritis.

Surgical Rescue in a High-volume Urban Emergency General Surgery Service at a Middle-income Country.

Introduction: The capacity for prompt "rescue" from death in patients with complications has become an important marker of the quality of care since mortality and morbidity have been identified as incongruous indicators. This study aims to describe the incidence of "surgical rescue" failure and the outcomes of emergency general surgery (EGS) patients at a large academic medical center. Materials and methods: In our high-volume surgical hospital, an electronic EGS registry was developed to automatically capture in-hospital information and outcomes from the Electronic Medical Record (EMR). Surgical complications were included in an online application and automatically captured in the electronic EGS registry, and prospectively screened from June to July 2017 for acute EGS surgical patients from operative procedures. Results: A total of 501 patients (average age: 53.9 ± 20.9, 56.5% female) underwent 882 EGS procedures. Thirteen patients (2.6%) of the 501 patients required "surgical rescue", mainly for uncontrolled sepsis (43%) and anastomotic leakage (30%). The surgical rescue failure rate (inability to prevent death after a surgical complication) was 15.4%. Patients requiring critical care (OR = 3.3, IC 95%: 1.04, 10.5), hospital admission (p = 0.038), and hospital LOS (days) (p = 0.004) were significantly higher for the surgical rescue patients than for those without complications. Conclusion: Surgical failure to rescue rate was similar among high-volume EGS services, as has recently been described in the United States. The latest development and implementation of an electronic automatic captured EGS registry database in our academic medical center will serve to build best practices for "surgical rescue" and drive quality improvement programs.

Biomarkers of susceptibility and effect in car painters exposed to organic solvents.

INTRODUCTION: Car painters are routinely exposed to organic solvents classified as carcinogenic and mutagenic substances. OBJECTIVE: To characterize the population susceptibility and evaluate the genotoxic effects of exposure to organic solvents. METHODS: A cross-sectional study comparing a group of car painters exposed to organic solvents with a non-exposed group. CYP2E1 polymorphisms and the presence of micronuclei in lymphocytes were determined. RESULTS: One hundred twenty-two workers participated in the study: 62 who worked in car paint shops and were exposed to solvents, and 60 who were not exposed. There were statistically significant differences between the two groups regarding micronucleated cells and nucleoplasmic bridges frequencies (p= 0.042 and p= 0.046, respectively; exact likelihood ratio). Significant differences were found at the interaction between the CYP2E1 genotype c1c1 and occupational exposure to solvents, with higher frequencies of micronuclei (p= 0.013) and micronucleated cells (p= 0.015). However, when the frequencies of micronuclei, micronucleated cells and nucleoplasmic bridges in the exposure group were compared between the c1c1 and c2c2/c1c2 allele groups of the CYP2E1 polymorphism, statistically significant differences were found. CONCLUSIONS: This study confirms that when workers with CYP2E1 polymorphisms, specifically the c1c1 genotype, are exposed to organic solvents, they are more likely to have somatic cell mutations, a condition associated with increased susceptibility to diseases such as cancer.

INTRODUCCIÓN: Los pintores de vehículos automotores están rutinariamente expuestos a agentes como los solventes orgánicos, capaces de producir efectos mutágenos y carcinógenos. OBJETIVO: Caracterizar la susceptibilidad poblacional y evaluar los efectos genotóxicos debidos a la exposición a solventes orgánicos. MÉTODOS: Estudio de corte transversal que comparó a un grupo de pintores de carros expuestos a solventes orgánicos con un grupo de personas no expuestas. Fueron determinados tanto los polimorfismos de CYP2E1 como la presencia de micronúcleos en linfocitos. RESULTADOS: Participaron 122 personas, 62 trabajadores de talleres de pintura de autos expuestos a solventes y 60 personas no expuestas. Con relación al cuestionario Q 16, 32% de los expuestos refirieron síntomas sugestivos de neurotoxicidad. Las frecuencias de células micronucleadas y de puentes nucleoplásmicos fueron significativamente mayores en los expuestos que en los no expuestos: p= 0.042 y p= 0.046, respectivamente, Razón de verosimilitud exacta). Fueron halladas diferencias significativas en la interacción de CYP2E1 (c1c1) y la exposición ocupacional a solventes, con mayores frecuencias de micronúcleos (p= 0.013) y de células micronucleadas (p= 0.015). CONCLUSIONES: Este estudio reafirma que los trabajadores expuestos a solventes orgánicos con polimorfismos de CYP2E1, específicamente con genotipo c1c1, tienen mayor probabilidad de presentar mutaciones en las células somáticas, condición asociada con una mayor susceptibilidad a enfermedades como el cáncer.

Elevated levels of D-dimer tested by immunoturbidimetry are associated with the extent of severity of pre-eclampsia.

OBJECTIVE: To establish the association between increased levels of D-dimer and severity of pre-eclampsia. METHODS: A nested, prospective cohort, analytical case-control study was conducted among women with pre-eclampsia between March 2017 and March 2018. Inclusion criteria were age over 18 years, gestational age of more than 20 weeks, a single pregnancy with a living fetus, and a diagnosis of pre-eclampsia. D-dimer was measured by immunoturbidimetry at the time of diagnosis of pre-eclampsia, applying cut-off points adjusted for gestational age. Statistical analysis involved unconditional logistic regression for the association of elevated D-dimer with severe pre-eclampsia adjusted by confounding variables. RESULTS: There were 132 patients with pre-eclampsia, of which 44 were classed as controls and 88 were classed as having severe pre-eclampsia (case group). Cohort characteristics included: age between 18 and 45 years (mean 28.0 ± 6.3 years); presence of gestational hypertension (10.6%), chronic arterial hypertension (9.0%); and gestational diabetes (5.3%). In the case group, levels of D-dimer were significantly higher than in controls (19.3% vs 2.3%, odds ratio [OR] 10.30, 95% confidence interval [CI] 1.32-80.14, P=0.004) as well as significant in the unconditional logistic regression model adjusted for maternal age, parity, gestational age, and comorbidities (OR 10.02, 95% CI 1.28-78.68, P=0.028). CONCLUSION: Elevated levels of D-dimer and severe pre-eclampsia are strongly associated, reinforcing evidence that one of the physiopathologic bases of the condition is the activation of fibrinolysis and the coagulation system.

Biomarkers of susceptibility and effect in car painters exposed to organic solvents / Biomarcadores de susceptibilidad y efecto en pintores de carros expuestos a solventes orgánicos

Abstract Introduction: Car painters are routinely exposed to organic solvents classified as carcinogenic and mutagenic substances. Objective: To characterize the population susceptibility and evaluate the genotoxic effects of exposure to organic solvents. Methods: A cross-sectional study comparing a group of car painters exposed to organic solvents with a non-exposed group. CYP2E1 polymorphisms and the presence of micronuclei in lymphocytes were determined. Results: One hundred twenty-two workers participated in the study: 62 who worked in car paint shops and were exposed to solvents, and 60 who were not exposed. There were statistically significant differences between the two groups regarding micronucleated cells and nucleoplasmic bridges frequencies (p=0.042 and p=0.046, respectively; exact likelihood ratio). Significant differences were found at the interaction between the CYP2E1 genotype c1c1 and occupational exposure to solvents, with higher frequencies of micronuclei (p= 0.013) and micronucleated cells (p= 0.015). However, when the frequencies of micronuclei, micronucleated cells and nucleoplasmic bridges in the exposure group were compared between the c1c1 and c2c2/c1c2 allele groups of the CYP2E1 polymorphism, statistically significant differences were found. Conclusions: This study confirms that when workers with CYP2E1 polymorphisms, specifically the c1c1 genotype, are exposed to organic solvents, they are more likely to have somatic cell mutations, a condition associated with increased susceptibility to diseases such as cancer

Resumen Introducción: Los pintores de vehículos automotores están rutinariamente expuestos a agentes como los solventes orgánicos, capaces de producir efectos mutágenos y carcinógenos. Objetivo: Caracterizar la susceptibilidad poblacional y evaluar los efectos genotóxicos debidos a la exposición a solventes orgánicos. Métodos: Estudio de corte transversal que comparó a un grupo de pintores de carros expuestos a solven tes orgánicos con un grupo de personas no expuestas. Fueron determinados tanto los polimorfismos de CYP2E1 como la presencia de micronúcleos en linfocitos. Resultados: Participaron 122 personas, 62 trabajadores de talleres de pintura de autos expuestos a solventes y 60 personas no expuestas. Con relación al cuestionario Q 16, 32% de los expuestos refirieron síntomas sugestivos de neurotoxicidad. Las frecuencias de células micronucleadas y de puentes nucleoplásmicos fueron significativamente mayores en los expuestos que en los no expuestos: p= 0.042 y p= 0.046, respectivamente, Razón de verosimilitud exacta). Fueron halladas diferencias significativas en la interacción de CYP2E1 (c1c1) y la exposición ocupacional a solventes, con mayores frecuencias de micronúcleos (p= 0.013) y de células micronucleadas (p= 0.015). Conclusiones: Este estudio reafirma que los trabajadores expuestos a solventes orgánicos con polimorfismos de CYP2E1, específicamente con genotipo c1c1, tienen mayor probabilidad de presentar mutaciones en las células somáticas, condición asociada con una mayor susceptibilidad a enfermedades como el cáncer

Risk of vasectomy failure by ligation and excision with fascial interposition: A prospective descriptive study.

OBJECTIVE: To evaluate the occlusive failure risk of ligation and excision with fascial interposition vasectomy technique. There are doubts about the effectiveness of this technique largely used in Asia and Latin America. STUDY DESIGN: We conducted a prospective longitudinal observational descriptive study among men who underwent a vasectomy performed under local anesthesia in a clinic specializing in sexual and reproductive health services in Bogotá, Colombia. Three urologists used the Percutaneous No-Scalpel Vasectomy technique to isolate the vas deferens. They then ligated the vas, excised a 1 cm segment between ligations, and ligated the fascia on the prostatic end to cover the testicular end. We requested all patients to submit a semen sample three months after the vasectomy. We defined probable and confirmed vasectomy failure as 1-4.9 million sperm/ml and 5 million sperm/ml or more or any number of motile sperm observed on the last semen sample available, respectively. RESULTS: Among 1149 participants, 581 (51%) had at least one post-vasectomy semen analysis. The overall failure risk was 5.2% (30/581; 95% confidence interval [CI] 3.6%-7.3%) with probable and confirmed failure risk of 1.9% (11/581; 95% CI 1.1%-3.4%) and 3.3% (19/581; 95% CI 2.1%-5.1%), respectively. Older men and one urologist had statistically significant higher risk of overall failure. CONCLUSION: Our study confirmed that the ligation and excision with fascial interposition vasectomy technique is associated with an unacceptable risk of failure. IMPLICATIONS: Surgeons who use the ligation and excision with fascial interposition vasectomy technique and countries with large vasectomy programs in Asia and Latin America that still recommend this technique should consider adopting alternatives to reduce the failure risk to below 1% as recommended by the American Urological Association.

Prevalence of pneumoconiosis and spirometric findings in underground mining workers in Cundinamarca, Colombia / Prevalencia de neumoconiosis y hallazgos espirométricos en trabajadores de minería subterránea en Cundinamarca, Colombia

Abstract Introduction: Coal worker's pneumoconiosis is caused by the inhalation of coal dust and its accumulation in the lungs after several years of exposure. Objective: To determine the prevalence of pneumoconiosis in underground mining workers exposed to coal dust in Cundinamarca, Colombia, and its association with their spirometry results and respiratory symptoms. Materials and methods: Cross-sectional study conducted on 215 workers who were administered a questionnaire on respiratory symptoms. For each worker a chest radiograph was taken according to the criteria of the International Labor Organization. Information on the workers' socio-demographic characteristics, smoking habits, and spirometry results was included. Results: The average age was 45.5 ± 9.4 years and the average length of employment was 21.7±10.0 years. Expectoration was the symptom most frequently reported (73.5%). Regarding spirometry results, a normal pattern was observed in 89.8% of the sample, while obstructive and restrictive patterns were found in 5.1% and 3.7% of the subjects, and 0.5% had a peripheral airways dysfunction pattern. The prevalence of pneumoconiosis was 42.33%. FEV1/FVC ratio (81.75 vs. 83.74, p=0.045) and FF25-75% (84.96 vs. 91.95, p<0.001) mean values were significantly lower in workers with pneumoconiosis. Conclusion: Pneumoconiosis was highly prevalent in the study population and its diagnosis was associated with spirometry results (FEV1/FVC and FEF25.75%); bearing in mind that currently there are not effective treatments for this disease, it is necessary to implement control and prevention strategies aimed at reducing occupational exposure to coal dust and, this way, prevent its occurrence.

Resumen Introducción. La neumoconiosis de los mineros de carbón resulta de la inhalación de polvo del carbón y se desarrolla después de varios años de exposición. Objetivo. Determinar la prevalencia de neumoconiosis y su relación con los resultados de espirometría y los síntomas respiratorios en trabajadores expuestos a polvo de carbón en Cundinamarca, Colombia. Materiales y métodos. Estudio de corte transversal realizado en 215 trabajadores a quienes se les aplicó un cuestionario sobre síntomas respiratorios y se les realizó radiografía de tórax según los criterios de la Organización Internacional del Trabajo. Se incluyó la información relativa a sus características sociodemográficas, hábitos de tabaquismo y resultados de espirometría. Resultados. El promedio de edad fue 45.5±9.4 años y el de experiencia laboral fue de 21.7±10.0 años. El síntoma más frecuente fue la expectoración (73.5%). En la espirometría, se observó patrón normal en el 89.8% de la población, obstructivo en el 5.1%, restrictivo en el 3.7% y de alteración de vías aéreas periféricas en el 0.5%. La prevalencia de neumoconiosis fue de 42.3%. Los valores promedio de FEV1/CVF (81.75 vs. 83.74, p=0.045) y FF25-75% (84.96 vs. 91.95, p<0.001) fueron menores significativamente en los mineros con neumoconiosis. Conclusión. La prevalencia de neumoconiosis fue muy alta en la población estudiada y su ocurrencia estuvo asociada a los resultados de la espirometría (FEV1/CFV y FEF25-75%); teniendo en cuenta que no hay tratamientos eficaces para esta enfermedad, es necesario implementar estrategias de control y prevención diseñadas para reducir la exposición laboral al polvo de carbón y, de esta forma, prevenir su aparición.

Detection of mammagloblin by RT-PCR as a biomarker for lymph node metastasis in breast cancer patients: A systematic review and meta-analysis.

BACKGROUND: This meta-analysis presents evidence regarding the diagnostic accuracy of mammaglobin detected using the RT-PCR technique, related to the presence of sentinel node metastasis in breast cancer patients. METHODS: The following databases were consulted: Cochrane, Lilacs, Scielo, Hinary, PubMed, Elsevier, Embase, ProQuest, the Universidad del Rosario´s Centro de Recursos Para el Aprendizaje y la Investigación (CRAI-UR) [Resource Center for Learning and Research], and the Google Scholar search engine. The quality of the studies was assessed using the QUADAS-2 and CASpe tools. The selected studies presented the necessary data to calculate diagnostic validity index of mammaglobin detection using RT-PCR, compared with the reference standard test. Global values for the sensitivity, specificity, positive predictive value, negative predictive value, probability ratios, diagnostic ORs, and summary ROC curves of this meta-analysis were obtained using the Meta-DiSc 1.4 program. RESULTS: Initially, 731 articles were obtained; but only 25 were included in the meta-analysis. Sensitivity was 84% (95% CI: 83% - 86%), and specificity was 92% (95% CI: 91% - 93%). Positive and negative predictive values were 9.26 (95% CI: 6.47-13.26) and 0.17 (95% CI: 0.13-0.23), respectively. The diagnostic OR was 66.34 (95% CI: 42.52-103.52). The predictive area under the sROC curve was 94.78 (Q = 0.8876). CONCLUSIONS: The evaluated diagnostic index showed that the expression of the mammaglobin biomarker has diagnostic prediction for detecting lymph node metastasis in breast cancer patients, when analyzed using RT-PCR, although more than 50% heterogeneity was found.

Evaluación de la exposición al polvo de carbón y de sílice en sitios de minería subterránea en tres departamentos de Colombia / Evaluation of the exposure to coal dust and prevalence of pneumoconiosis in underground mining in three Colombian departments

Introducción. La neumoconiosis de mineros del carbón es una enfermedad crónica e irreversible que se considera un problema de salud pública. Objetivo. Estimar la prevalencia de neumoconiosis y sus factores asociados en mineros de carbón de Boyacá, Cundinamarca y Norte de Santander. Materiales y métodos. Se hizo un estudio de corte transversal en 476 mineros. Se les hizo valoración médica, se tomaron radiografías de tórax siguiendo los criterios de la Organización Internacional del Trabajo, así como espirometrías, y se identificaron los polimorfismos de la glutatión S-transferasa y de las enzimas de reparación. Las asociaciones entre las condiciones ocupacionales y de la empresa con la neumoconiosis, se estudiaron usando modelos de regresión de Cox. Resultados. En 31 empresas se hicieron 479 monitorizaciones ambientales y se evaluaron 476 trabajadores cuyo tiempo de trabajo fluctuaba entre 10 y 57 años. La prevalencia de la neumoconiosis fue de 33,8 % (IC95% 27,0-41,3). En el modelo de regresión multivariado de Cox, con tiempo de riesgo constante para la neumoconiosis, esta se asoció significativamente con el trabajo en empresas medianas (razón de prevalencias, RP=2,00; IC95% 0,995- 2,690; p=0,052), con un nivel alto de exposición al polvo de carbón según el índice de exposición (RP=2,055; IC95% 1,043-4,048; p=0,038), y una antigüedad de 25 años o más (para 25,0 a 29,9 años: RP=2,199; IC95% 1,449-3,338; p=0,001). Conclusiones. La prevalencia de la neumoconiosis fue muy alta y se asoció a la exposición a altos niveles de polvo de carbón, a una exposición laboral mayor o igual a 25 años y al trabajo en empresas medianas.

Introduction: Coal workers' pneumoconiosis is a chronic and irreversible disease representing a public health problem. Objective: To estimate the prevalence of pneumoconiosis and its associated factors among underground coal miners in the Colombian departments of Boyacá, Cundinamarca and Norte de Santander. Materials and methods: We conducted a cross-sectional study of 476 miners to measure the prevalence of pneumoconiosis and its associated factors such as coal dust and silica levels, as well as the occupational conditions. The medical assessment and a chest x-ray were performed according to the International Labor Organization criteria, along with spirometry and the identification of glutathione S-transferase and repair enzyme polymorphisms. The associations were explored using Cox regression models. Results: We performed a total of 479 environmental monitoring sessions in 31 companies and we evaluated 476 workers with 10 to 57 years of mining work experience. The prevalence of pneumoconiosis was 33.8% (95% CI: 27.0 - 41.3%). In the Cox multivariate regression model with a constant risk time, pneumoconiosis was significantly associated with working in medium-sized companies (PR=2.00, 95% CI: 0.995 - 2.690; p=0.052), the level of severe exposure to coal dust (PR=2.055, 95% CI: 1.043 - 4.048; p=0.038), and working in underground mining for 25 years or more (for those with 25.0-29.9 years: PR=2.199, 95% CI: 1.449 - 3.338; p=0.001). Conclusions: The prevalence of pneumoconiosis was very high and was found to be associated with severe exposure to coal dust, work exposure for 25 years or more and working in medium-sized enterprises.

Evaluation of the exposure to coal dust and prevalence of pneumoconiosis in underground mining in three Colombian departments / Evaluación de la exposición al polvo de carbón y de sílice en sitios de minería subterránea en tres departamentos de Colombia

Introduction: Coal workers' pneumoconiosis is a chronic and irreversible disease representing a public health problem. Objective: To estimate the prevalence of pneumoconiosis and its associated factors among underground coal miners in the Colombian departments of Boyacá, Cundinamarca and Norte de Santander. Materials and methods: We conducted a cross-sectional study of 476 miners to measure the prevalence of pneumoconiosis and its associated factors such as coal dust and silica levels, as well as the occupational conditions. The medical assessment and a chest x-ray were performed according to the International Labor Organization criteria, along with spirometry and the identification of glutathione S-transferase and repair enzyme polymorphisms.The associations were explored using Cox regression models. Results: We performed a total of 479 environmental monitoring sessions in 31 companies and we evaluated 476 workers with 10 to 57 years of mining work experience. The prevalence of pneumoconiosis was 33.8% (95% CI: 27.0 - 41.3%). In the Cox multivariate regression model with a constant risk time, pneumoconiosis was significantly associated with working in medium-sized companies (PR=2.00, 95% CI: 0.995 - 2.690; p=0.052), the level of severe exposure to coal dust (PR=2.055, 95% CI: 1.043 - 4.048; p=0.038), and working in underground mining for 25 years or more (for those with 25.0-29.9 years: PR=2.199, 95% CI: 1.449 - 3.338; p=0.001). Conclusions: The prevalence of pneumoconiosis was very high and was found to be associated with severe exposure to coal dust, work exposure for 25 years or more and working in medium-sized enterprises

Introducción. La neumoconiosis de mineros del carbón es una enfermedad crónica e irreversible que se considera un problema de salud pública. Objetivo. Estimar la prevalencia de neumoconiosis y sus factores asociados en mineros de carbón de Boyacá, Cundinamarca y Norte de Santander. Materiales y métodos. Se hizo un estudio de corte transversal en 476 mineros. Se les hizo valoración médica, se tomaron radiografías de tórax siguiendo los criterios de la Organización Internacional del Trabajo, así como espirometrías, y se identificaron los polimorfismos de la glutatión S-transferasa y de las enzimas de reparación. Las asociaciones entre las condiciones ocupacionales y de la empresa con la neumoconiosis, se estudiaron usando modelos de regresión de Cox. Resultados. En 31 empresas se hicieron 479 monitorizaciones ambientales y se evaluaron 476 trabajadores cuyo tiempo de trabajo fluctuaba entre 10 y 57 años. La prevalencia de la neumoconiosis fue de 33,8 % (IC95% 27,0-41,3). En el modelo de regresión multivariado de Cox, con tiempo de riesgo constante para la neumoconiosis, esta se asoció significativamente con el trabajo en empresas medianas (razón de prevalencias, RP=2,00; IC95% 0,995- 2,690; p=0,052), con un nivel alto de exposición al polvo de carbón según el índice de exposición (RP=2,055; IC95% 1,043-4,048; p=0,038), y una antigüedad de 25 años o más (para 25,0 a 29,9 años: RP=2,199; IC95% 1,449-3,338; p=0,001). Conclusiones. La prevalencia de la neumoconiosis fue muy alta y se asoció a la exposición a altos niveles de polvo de carbón, a una exposición laboral mayor o igual a 25 años y al trabajo en empresas medianas.