Design and testing of an optical instrument for skin flap monitoring.

Flap procedures are complex surgical tools widely used in reconstructive surgery. Flap ischemia is one of the most dangerous complications, both during the surgical procedure and during the patient's recovery, which can quickly lead to tissue necrosis (flap loss) with serious medical and psychological consequences. Today, bedside clinical assessment remains the gold standard for flap monitoring, but timely detection of flap ischemia is a difficult and challenging task, so auxiliary techniques are needed to support flap monitoring. Here we present a prototype of a new optical diagnostic tool, based on visible light absorption in diffuse reflectance spectroscopy, for non-invasive, continuous, real-time monitoring of flaps. The proposed approach is assessed by monitoring flap ischemic scenarios induced on pig animal models. The results obtained support that the proposed approach has great potential, not only for prompt detection of ischemia (in seconds), but also for clear differentiation between an arterial occlusion and venous occlusion.

Resilience as an Independent Predictor of Bowel Related Quality of Life After Spinal Cord Injury.

Bowel dysfunction remains a prominent priority in the rehabilitation of patients with spinal cord injuries (SCIs). However, our understanding of the factors that influence bowel-related quality of life (QoL) in this population remains limited. This study aimed to investigate the potential role of resilience, defined as an individual's capacity to cope with and adapt to adversity, as a predictor of bowel-related QoL among the patients with SCI. A cohort of adult patients with SCI who received bowel and bladder care at an outpatient clinic within a large rehabilitation hospital was identified through a prospectively collected database. Resilience was measured using the Spinal Cord Injury-Quality of Life (SCI-QOL) Resilience Short Form, whereas bowel QoL was assessed using the Irritable Bowel Syndrome-Quality of Life (IBS-QoL) questionnaire. Univariate and multivariate regression analyses were employed to identify predictors of bowel-related QoL. The examined variables included age, gender, level and completeness of injury, time since injury, hand function, resilience, and the severity of bowel dysfunction as measured using the Neurogenic Bowel Dysfunction Score (NBDS). A total of 73 patients participated in this study, with a mean age of 44.01 ± 13.43 years and comprising mostly men (n = 57, 78%). The results revealed a significant correlation between resilience scores and the total score of IBS-QoL (ρ = -0.47, p < 0.0001). The multivariate analysis demonstrated that both resilience and the severity of bowel dysfunction were significant independent predictors of bowel-related QoL, with resilience demonstrating a stronger association. Overall, this study elucidates the importance of resilience in shaping patients' perceptions of their bowel health within the SCI population. In addition to the more expected determinants of bowel-related QoL, such as the severity of bowel dysfunction, resilience emerged as a notable factor. Accordingly, integrating interventions that enhance resilience within bowel rehabilitation programs may yield improvements in patients' perceived bowel health beyond the benefits achievable through bowel function enhancement alone.

Effectiveness of artificial intelligence-assisted colonoscopy in early diagnosis of colorectal cancer: a systematic review.

INTRODUCTION: As artificial intelligence (AI)-assisted diagnosis gained immense popularity, it is imperative to consider its utility and efficiency in the early diagnosis of colorectal cancer (CRC), responsible for over 1.8 million cases and 881 000 deaths globally, as reported in 2018. Improved adenoma detection rate, as well as better characterizations of polyps, are significant advantages of AI-assisted colonoscopy (AIC). This systematic review (SR) investigates the effectiveness of AIC in the early diagnosis of CRC as compared to conventional colonoscopy. MATERIALS AND METHODS: Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science were reviewed for original studies (randomized controlled trials, observational studies), SRs, and meta-analysis between 2017 and 2022 utilizing Medical Subject Headings terminology in a broad search strategy. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and were conducted from November 2022. A data extraction form based on the Cochrane Consumers and Communication Review group's extraction template for quality assessment and evidence synthesis was used for data extraction. All included studies considered for bias and ethical criteria and provided valuable evidence to answer the research question. RESULTS: The database search identified 218 studies, including 87 from PubMed, 60 from SCOPUS, and 71 from Web of Science databases. The retrieved studies from the databases were imported to Rayyan software and a duplicate article check was performed, all duplicate articles were removed after careful evaluation of the data. The abstract and full-text screening was performed in accordance with the following eligibility criteria: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational studies; Preferred Reporting Items for Systematic Reviews and Meta-Analysis for review articles, ENTREQ for narrative studies; and modified JADAD for randomized controlled trials. This yielded 15 studies that met the requirements for this SR and were finally included in the review. CONCLUSION: AIC is a safe, highly effective screening tool that can increase the detection rate of adenomas, and polyps resulting in an early diagnosis of CRC in adults when compared to conventional colonoscopy. The results of this SR prompt further large-scale research to investigate the effectiveness in accordance with sex, race, and socioeconomic status, as well as its influence on prognosis and survival rate.

Cricotracheal Adenoid Cystic Carcinoma: Insights Into the Diagnosis and Management of an Uncommon Anatomic Variant.

Adenoid cystic carcinoma (ACC) is the second most common malignant salivary gland tumor and accounts for 30% of minor salivary gland tumors. Its location in the larynx and trachea are rare. We present the case of a 45-year-old healthy male whose MRI revealed a posterior endoluminal tumor that invaded the posteroinferior perichondrium of the cricoid lamina and displaced the hypopharynx and esophagus. A left-limited cervical surgical exploration and an intraluminal incisional biopsy through the tracheostomy space were performed by another surgical team. The pathological study reported an ACC, T4aN0M0, stage IVA tumor. Then, a circular tracheal resection and an excision of the inferior part of the posterior cricoid lamina were carried out. The macroscopic study showed a lesion, 3cm long, 2.2cm wide, and 1cm thick, located at the posterior wall of the cricoid cartilage and proximal trachea. Only the upper margin was compromised. Microscopically, the tumor showed tubular, solid, cribriform, and trabecular patterns. One and a half years after surgery, the patient still has bilateral vocal cord mobility and normal speech. It is clear that a contrast-enhanced CT scan is useful to assess tumor extent and growth pattern in these rare variants. Among treatment alternatives, surgery sometimes complemented with radiotherapy is essential; constant follow-up is mandatory.

Differentiated thyroid cancer clinical trends in Quito, Ecuador / Tendencias clínicas del cáncer diferenciado de tiroides en Quito, Ecuador

Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found. Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found.

Introducción. El cáncer de tiroides es actualmente el cáncer más frecuente en la mujer en Ecuador. El presente estudio ha tenido como objetivo evaluar los cambios en la presentación clínica y el diagnóstico del cáncer diferenciado de tiroides en un hospital de tercer nivel de Quito, Ecuador. Material y Métodos. El presente es un estudio retrospectivo de casos realizado en tres períodos consecutivos desde 1990 a 2019 en un hospital del tercer nivel en Quito, Ecuador. Los expedientes clínicos de 875 pacientes tratados quirúrgicamente por un cáncer diferenciado de tiroides fueron revisados. Los datos demográficos, clínicos, de imagen y patología fueron extraídos y analizados. Resultados. Se encontraron tendencias significativas hacia una edad más avanzada, nivel educativo más alto, menos tumores palpables, menos adenopatías regionales palpables, menos metástasis a distancia, más exámenes de ultrasonido y tomografía, más estudios de citología, más tumores pequeños y pacientes con estadío I y más descripciones de las variantes histológicas. Conclusiones. El cáncer de tiroides no sólo que ha aumentado continuamente en su frecuencia en los años recientes, sino que la presentación clínica, el manejo diagnóstico y terapéutico ha cambiado significativamente en las tres últimas décadas.

Insuficiencia respiratoria asociada con la hipomagnesemia extrema en un paciente con colitis ulcerativa. Reporte de caso y revisión de la literatura / Ventilatory failure associated with extreme hypomagnesemia in a patient with ulcerative colitis: case report and literatura review

RESUMEN La hipomagnesemia es un trastorno electrolítico asociado con la disminución de los aportes nutricionales, las pérdidas gastrointestinales y la depuración renal del magnesio, un catión divalente que, al tener una mayor concentración a nivel intracelular, dificulta el análisis de su déficit absoluto y el establecimiento de una adecuada corrección que supla las pérdidas y los requerimientos diarios que son aproximadamente 360 mg por día. Es por esto que el conocimiento de las etiologías de la hipomagnesemia, al igual que el cálculo de la fracción excretada de magnesio y la medición de la magnesiuria en 24 horas, son herramientas útiles para establecer pautas adecuadas de corrección continua de magnesio con el fin de evitar las complicaciones asociadas con su toxicidad o una corrección deficiente que perpetúe dicho trastorno electrolítico, lo cual puede generar una sintomatología tan grave como la tetania o la insuficiencia respiratoria. La paciente descrita, en ausencia de estado de choque o trastorno ácido base, requirió ingreso a la unidad de cuidados intensivos para ventilación mecánica invasiva y corrección de sus trastornos electrolíticos asociados con la colitis ulcerativa (hipocalcemia, hipocalemia e hipomagnesemia).

SUMMARY Hypomagnesemia is an electrolyte disorder associated with decreased nutritional intake, gastrointestinal losses, and renal clearance of magnesium, a divalent cation that, having a higher concentration at the intracellular level, makes it difficult to analyze its absolute deficit and establish an adequate correction that supplies daily losses and requirements; For this reason, knowledge of the etiologies of hypomagnesemia, as well as the calculation of the excreted fraction of magnesium and measurement of magnesiuria in 24 hours, are useful tools to establish adequate guidelines for continuous magnesium correction, in order to avoid complications associated with its toxicity or poor correction that perpetuates this electrolyte disorder, and generates the appearance of symptoms as severe as tetany and ventilatory failure. These severe manifestations were present in the patient described, who, in the absence of shock or base acid disorder, required admission to the intensive care unit for invasive mechanical ventilation and correction of their electrolyte disorders associated with ulcerative colitis (hypocalcemia, hypokalemia, and hypomagnesemia).

Cardiovascular vulnerability in COVID-19 elderly patients: getting into the biological mechanisms / Vulnerabilidad cardiovascular en adultos mayores con COVID-19: conociendo los mecanismos biológicos

The COVID-19 pandemic has had an important impact on older adults, conferring a worse prognosis. Older adults may have atypical presentations, which can delay the diagnosis of the disease, making its evolution more unfavorable. In addition to the cardiovascular damage mechanisms conferred by SARS-CoV-2 infection, the changes inherent in the aging cardiovascular and immune system favor the appearance of cardiovascular complications in a more relevant way in this population. The objective of this article will be to summarize the knowledge about cardiovascular involvement in older adults and explain its pathophysiological mechanisms, to alert about the early recognition and timely treatment of these complications.

La pandemia por COVID-19 ha impactado de forma importante en los adultos mayores, confiriéndoles un peor pronóstico. Los adultos mayores pueden tener presentaciones atípicas, las cuales pueden retrasar el diagnóstico de la enfermedad, haciendo su evolución más desfavorable. Además de los mecanismos de daño cardiovascular conferidos por la infección por SARS-CoV-2, los cambios inherentes al sistema cardiovascular e inmune ya envejecido, favorecen la aparición de complicaciones cardiovasculares de forma más relevante en esta población. El objetivo de este artículo será resumir los conocimientos sobre el involucro cardiovascular en adultos mayores y explicar los mecanismos fisiopatológicos de este, para alertar sobre el reconocimiento temprano y tratamiento oportuno de estas complicaciones.

Branchial Cysts in Quito, Ecuador

Abstract Introduction Branchial cleft anomalies are the second most common congenital anomaly in children. However, some lesions may not develop clinically and are not diagnosed until adulthood. The recent literature of branchial cysts (BCs) in the adult population is really scanty. For this reason, we analyzed the clinical and surgical management of the adult population treated for a BC at a tertiary care general hospital. Methods A retrospective review of the clinical records of all the patients with histological diagnosis of BC who were surgically treated at the Social Security Hospital in Quito, Ecuador, was performed. Fifty-one patients (27 women) with congenital anomalies of the 2nd (43 patients with cysts) and 3rd (6 patients with cysts and 2 with fistula) branchial arches were diagnosed and treated. Diagnosis was made on clinical grounds and by computed tomography scan. Results The 43 patients with a 2nd branchial cleft cyst underwent complete surgical excision through a wide mid-neck transverse cervicotomy. The 6 cases of 3rd branchial cleft cyst underwent surgical resection through a lower-neck transverse incision, and the 2 patients with clinical fistula in the lower aspect of the neck were operated on via an elliptical incision around this external fistula opening. Postoperative evolution was uneventful in all patients. Conclusions Branchial cysts can occasionally be diagnosed in adult patients in the setting of a general hospital population. A correct clinical and imaging assessment was diagnostic in most patients. Complete surgical resection was curative in all our patients, and postoperative complications were exceptional.

Branchial Cysts in Quito, Ecuador.

Introduction Branchial cleft anomalies are the second most common congenital anomaly in children. However, some lesions may not develop clinically and are not diagnosed until adulthood. The recent literature of branchial cysts (BCs) in the adult population is really scanty. For this reason, we analyzed the clinical and surgical management of the adult population treated for a BC at a tertiary care general hospital. Methods A retrospective review of the clinical records of all the patients with histological diagnosis of BC who were surgically treated at the Social Security Hospital in Quito, Ecuador, was performed. Fifty-one patients (27 women) with congenital anomalies of the 2 nd (43 patients with cysts) and 3 rd (6 patients with cysts and 2 with fistula) branchial arches were diagnosed and treated. Diagnosis was made on clinical grounds and by computed tomography scan. Results The 43 patients with a 2 nd branchial cleft cyst underwent complete surgical excision through a wide mid-neck transverse cervicotomy. The 6 cases of 3 rd branchial cleft cyst underwent surgical resection through a lower-neck transverse incision, and the 2 patients with clinical fistula in the lower aspect of the neck were operated on via an elliptical incision around this external fistula opening. Postoperative evolution was uneventful in all patients. Conclusions Branchial cysts can occasionally be diagnosed in adult patients in the setting of a general hospital population. A correct clinical and imaging assessment was diagnostic in most patients. Complete surgical resection was curative in all our patients, and postoperative complications were exceptional.

Telemedicine as an instrument for cardiological consultation during the COVID-19 pandemic.

Telemedicine is an underused instrument along our healthcare systems. It´s a technological tool that optimizes resources, save money, expands our capacities, decongests our traditional medical services and is an invaluable help for teaching and research. The COVID-19 pandemic is forcing us to expand its use and it gives us the opportunity to design an appropriate implementation.

La telemedicina es una herramienta subutilizada en nuestros sistemas de atención sanitaria. Se trata de un recurso tecnológico que optimiza los servicios de salud, ahorra recursos, expande la capacidad de atención especializada a lugares remotos, descongestiona servicios médicos tradicionales y es un instrumento invaluable de enseñanza e investigación. La pandemia por COVID-19 nos obliga a extender su uso y supone una oportunidad para diseñar una adecuada implementación.

Efecto de la cocción sobre el índice glicémico del plátano (Musa paradisiaca) y la yuca (Manihot esculenta) / Effect of cooking on the glycemic index of the banana (Musa paradisiaca) and the yuca (Manihot esculenta)

Introducción: se evaluó el efecto que distintos tipos de cocción tienen sobre el índice glicémico del plátano (Musa paradisiaca) maduro y la yuca (Manihot esculenta), alimentos que comúnmente consume población venezolana. Materiales y métodos: el estudio fue de tipo descriptivo. Los alimentos se adquirieron en mercados locales y se probaron las técnicas de horneado, hervido (sancochado) y frito. Se trabajó con la preparación artesanal tipo "casabe" como el equivalente a la yuca horneada. Se seleccionó una muestra de 35 individuos sanos, de sexo masculino, entre 20 y 25 años de edad, quienes se dividieron de manera completamente aleatoria en siete grupos de cinco personas cada uno para suministrarles el plátano y la yuca en sus diferentes preparaciones, y un grupo como control para suministrarle el pan blanco (alimento control). A los sujetos se les midió la glicemia basal y se le suministraron 50 g del alimento; se tomaron muestras de sangre capilar a intervalos de 15 minutos hasta alcanzar su glicemia basal. Con estos datos se calcularon los índices glicémicos. Resultados: se encontró que para el plátano frito el IG fue de 12,16±2,67, signifcativamente menor (p<0,001) al horneado (IG=91,13±11,52) o sancochado (IG=48,43±9,73). En el caso de la yuca, se observó que el grupo que consumió casabe exhibió el mayor IG=65±5,79, signifcativamente superior (p<0,001) al ocasionado por la yuca sancochada (IG=24±3,51) y la sancochada/frita (IG=32±4,45). Conclusiones: los hallazgos obtenidos en el estudio determinaron que la aplicación de distintos procesos de cocción sobre el mismo alimento altera signifcativamente su índice glicémico.

Telemedicina como instrumento de consulta cardiológica durante la pandemia COVID-19 / Telemedicine as an instrument for cardiological consultation during the COVID-19 pandemic

Resumen La telemedicina es una herramienta subutilizada en nuestros sistemas de atención sanitaria. Se trata de un recurso tecnológico que optimiza los servicios de salud, ahorra recursos, expande la capacidad de atención especializada a lugares remotos, descongestiona servicios médicos tradicionales y es un instrumento invaluable de enseñanza e investigación. La pandemia por COVID-19 nos obliga a extender su uso y supone una oportunidad para diseñar una adecuada implementación.

Abstract Telemedicine is an underused instrument along our healthcare systems. It´s a technological tool that optimizes resources, save money, expands our capacities, decongests our traditional medical services and is an invaluable help for teaching and research. The COVID-19 pandemic is forcing us to expand its use and it gives us the opportunity to design an appropriate implementation.

La cirugía centrada en la persona / Surgery focused on the person

Contexto: la medicina centrada en la persona ha sido definida como "la práctica médica que se fundamenta en el respeto y seguimiento a las preferencias, necesidades y valores del paciente, elementos que deben guiar todas las decisiones clínicas. Discusión: en respuesta al paternalismo médico, se han propuesto cuatro principios básicos relativos a la posición del médico ante su paciente: la autonomía, la beneficencia, la no maleficencia y la justicia. El cirujano debe utilizar criterios realísticos, basados en estadísticas confiables y en la mejor evidencia clínica a fin de recomendar la mejor decisión terapéutica, evitando suscitar un optimismo inapropiado en el paciente y sus familiares. A veces, llegar a este umbral de pensamiento es difícil de obtener. Entre los principales obstáculos actuales a una medicina centrada en la persona se encuentran al menos dos. Por un lado, el gran volumen de pacientes que un médico tiene que atender, con el consiguiente estrés para el facultativo y la reducción del tiempo de atención. Conclusión: la relación entre paciente, familiares y cirujano debe ser lo más diáfana y afectiva para sobrellevar los obstáculos, presiones e inquietudes que rodean actualmente el desarrollo de un acto quirúrgico. Descriptores DeCs: cirugía, persona, humanismo (AU)

Context: person-centered medicine has been defined as "the medical practice that is based on the respect and follow-up of the patient's preferences, needs and values, elements that should guide all clinical decisions. Discussion: in response to medical paternalism, four basic principles have been proposed concerning the position of the doctor before his patient: autonomy, beneficence, non-maleficence and justice. The surgeon must use realistic criteria, based on reliable statistics and the best clinical evidence in order to recommend the best therapeutic decision, avoiding raising inappropriate optimism in the patient and their families. Sometimes, reaching this threshold of thought is difficult to obtain. Among the main current obstacles to a medicine centered on the person are at least two: the large volume of patients that a doctor has to attend, and the consequent stressfor the doctor and the reduction of attention time. Conclusion: the relationship between patient, family members and surgeon must be the most diaphanous and affective to overcome the obstacles, pressures and concerns that currently surround the development of a surgical act. (AU)